Sexual abstinence only programmes to prevent HIV infection in high income countries: systematic review
Open accessAbstract
OBJECTIVE: To assess the effects of sexual abstinence only programmes for HIV prevention among participants in high income countries. DESIGN: Systematic review. DATA SOURCES: 30 electronic databases without linguistic or geographical restrictions to February 2007, contacts with experts, hand searching, and cross referencing. REVIEW METHODS: Two reviewers independently applied inclusion criteria and extracted data, resolving disagreements by consensus and referral to a third reviewer. Randomised and quasirandomised controlled trials of abstinence only programmes in any high income country were included. Programmes aimed to prevent HIV only or both pregnancy and HIV. Trials evaluated biological outcomes (incidence of HIV, sexually transmitted infection, pregnancy) or behavioural outcomes (incidence or frequency of unprotected vaginal, anal, or oral sex; incidence or frequency of any vaginal, anal, or oral sex; number of partners; condom use; sexual initiation). RESULTS: The search identified 13 trials enrolling about 15,940 US youths. All outcomes were self reported. Compared with various controls, no programme affected incidence of unprotected vaginal sex, number of partners, condom use, or sexual initiation. One trial observed adverse effects at short term follow-up (sexually transmitted infections, frequency of sex) and long term follow-up (sexually transmitted infections, pregnancy) compared with usual care, but findings were offset by trials with non-significant results. Another trial observed a protective effect on incidence of vaginal sex compared with usual care, but this was limited to short term follow-up and countered by trials with non-significant findings. Heterogeneity prevented meta-analysis. CONCLUSION: Programmes that exclusively encourage abstinence from sex do not seem to affect the risk of HIV infection in high income countries, as measured by self reported biological and behavioural outcomes.
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Some of these studies had several methodological problems, as reviewers themselves recognize, which might account for the lack of significant findings.
“However, some of these studies had several methodological problems, as reviewers themselves recognize, which might account for the lack of significant findings.”
From Relationships, love and sexuality: what the Filipino teens think and feel (2009) · cites this paper as [74]
Some studies about abstinence programs have found no statistically significant effects on sexual behavior.
“It is true that some studies about abstinence programs have found no statistically significant effects on sexual behavior [73-75].”
From Relationships, love and sexuality: what the Filipino teens think and feel (2009) · cites this paper as [74]
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- Authors
- Underhill, K., Montgomery, P., & Operario, D.
- Affiliations
- University of Oxford (GB)
- Corresponding author
- Underhill, Kristen
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2007-07-26
- Volume
- 335
- Issue
- 7613
- Pages
- 248
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC1939793
- OpenAlex
- W2081409099
- Cited by
- 176
- References
- 4
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 7 · 2022: 5 · 2021: 8 · 2020: 4 · 2019: 10 · 2018: 7 · 2017: 5 · 2016: 11 · 2015: 11 · 2014: 8 · 2013: 7 · 2012: 10
- FWCI
- 4.45
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Adolescent Sexual and Reproductive Health
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- HIV prevention, sexual abstinence, sexually transmitted infections, unprotected sex, condom use, sexual initiation, number of sexual partners, contraception, adolescents, adolescent sexual health, high-income countries
- MeSH terms
- Humans, Income, Prognosis, Sexual Abstinence, HIV Infections, Randomized Controlled Trials as Topic, Developed Countries
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