The ABC’s of HIV Prevention Denialism

AbstiThe past decade has seen a relentless demand for placing sexual abstinence-only programs at the forefront of HIV prevention. Most notably is the official US HIV prevention policy for the ABC approach – Abstinence until marriage; advising those who are sexually active to Be faithful to one partner; and finally, urging Condom use, especially for those who have more than one sexual partner.

Despite repeated reviews of carefully controlled behavioral intervention trials, HIV prevention science has been ignored for the sake of conservative political agendas. For example, Underhill and colleagues identified 13 carefully controlled intervention trials that enrolled nearly16,000 US youths. "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.”

The authors concluded that “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.” [Underhill et al. BMJ].

In that respect, those who continue to insist on abstinence-only HIV prevention programs venture into the dark world of denialism.

Just like other variants of denialism (9/11, Holocaust, etc.), those who call for sexual abstinence-only prevention programs are wishfully thinking that adolescents won’t have sex if simply told not to. It is the same ‘Just Say No’ mentality that failed to prevent drug abuse.

Selectively attending to the science one wants to see is the hallmark of denialism. The proponents of abstinence-only programs, or more generally the ABC approach to prevention, have often pointed to success in Uganda where an HIV/AIDS catastrophe was averted in the 1990’s. The problem is that Uganda’s prevention success predated their adoption of the ABC slogan. In fact, in the years following the official use of the ABC slogan by President Museveni, Uganda’s AIDS problem has gotten worse.

For more information on the reality of Uganda’s HIV prevention success and the reasons why Uganda is now facing a growing HIV epidemic, you can read a series of excellent papers from people who were in Uganda in the 1990s. Four articles published in the peer-reviewed research journal AIDS and Behavior provide an excellent discussion on HIV/AIDS prevention in Uganda. The first article is an overview by Mike Merson now at Duke University. Merson was the Director of the WHO Global AIDS Program during the years that Uganda averted an HIV disaster. The impact of sexual behavior changes and the governmental response in Uganda’s HIV epidemic are detailed in an article by Ted Green and his colleagues at Harvard. Ron Gray, who has done extensive research in Uganda for decades comments on Green’s article. Finally, Gary Slutkin and his colleagues who were on the ground in Uganda during those critical years provide their perspective. All four articles can be accessed and downloaded free.

UPDATE: A study being published in the journal Pediatrics “Virginity Pledges Do Not Work, Yet Another Study Confirms” reports that teens who make a pledge to abstain from sex are no more likely to do so than other teens.

UPDATE: On January 23, 2009 President Obama reversed provisions of the Mexico City Policy allowing for funding of safe and effective voluntary family planning in developing countries.

The President said "I look forward to working with Congress to restore U.S. financial support for the U.N. Population Fund. By resuming funding to UNFPA, the U.S. will be joining 180 other donor nations working collaboratively to reduce poverty, improve the health of women and children, prevent HIV/AIDS and provide family planning assistance to women in 154 countries."

This is the first in what we hope will be a series of changes that refute Bush denialist policies.