Date Published: September 18, 2007
Publisher: Public Library of Science
Author(s): Shari L Dworkin, John Santelli
Abstract: The authors discuss the policy questions arising from a new study on “abstinence-plus” interventions for reducing HIV risk behavior among youth in high-income countries.
Partial Text: Abstinence until marriage has emerged as a primary policy goal in efforts to promote adolescent sexual and reproductive health—in the United States and increasingly world-wide. While few would argue with abstinence as a personal choice (no one should be forced to have sex), there are serious questions about whether government promotion of abstinence should be a public health goal. Marriage is not free of HIV risk. Early marriage—particularly of young women to older, sexually experienced men—carries a substantial risk of HIV infection. Around the globe, a young woman’s primary risk of HIV infection is often through sex with her husband .
The most vociferous criticism of abstinence as a public health goal has been directed toward abstinence-only education (i.e., education that presents abstinence as the best and only solution and restricts information about other prevention strategies such as condom use). Scientific and ethical objections to such education have come from the major professional organizations in the US focused on adolescent health, including the American Academy of Pediatrics, the Society for Adolescent Medicine, the American Medical Association, and the American Public Health Association [5–8].
A new systematic review by Kristen Underhill and colleagues in this issue of PLoS Medicine addresses a related approach to abstinence promotion—abstinence-plus interventions . In abstinence-plus education, participants are given a hierarchy of safe-sex strategies. At the top of the hierarchy is the promotion of sexual abstinence as the safest route to HIV prevention. Recognizing that some participants will not be abstinent, abstinence-plus approaches encourage individuals to also use condoms and to adopt other safer-sex strategies.
The authors argue that in their study of abstinence-plus interventions, “the promotion of abstinence did not appear to detract from the programs’ condom promotion message” . However, many programmatic and policy questions remain.