Sexual Abstinence Only Programmes to Prevent HIV Infection in High Income Countries: Systematic Review

BMJ, 2007

Posted: 26 Aug 2018 Last revised: 28 Oct 2018

Date Written: August 1, 2007


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. Randomized 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 behavioral 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 behavioral outcomes.

Keywords: HIV Prevention, Sexual Abstinence Only, AIDS, Public Health

Suggested Citation

Underhill, Kristen, Sexual Abstinence Only Programmes to Prevent HIV Infection in High Income Countries: Systematic Review (August 1, 2007). BMJ, 2007, Available at SSRN:

Kristen Underhill (Contact Author)

Columbia University - Law School ( email )

435 West 116th Street
New York, NY 10027

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