HIV Prevention Knowledge Base
Behavioral Interventions: Delayed Sexual Debut
Promoting Abstinence: Lessons From Four Countries Over Four Years
Youth for Life (MYFL) is an abstinence and behavior change program from World Relief targeting youth in four countries over five years. Funded by USAID and the President´s Emergency Plan for AIDS Relief (PEPFAR), and started in 2004, this project has reached 1.8 million youth and those who influence them, in Haiti, Kenya, Mozambique, and Rwanda. The program engages youth through interactive training and encourages abstinence before marriage and mutual faithfulness within it as a means to protect against HIV. To understand components of impact and to propose recommendations for improvement, World Relief conducted a mid-term evaluation in all four countries between May and September, 2007. Emergent themes reported by youth beneficiaries and youth influencers included a commitment to abstinence, partner reduction, improved school performance, and identification and reporting of sexual abuse. Youth report that the lessons on self-esteem and making good choices were pivotal to the programs’ impact in their lives; particularly effective was the use of peer role models that moved abstinent couples to marriage.
An Outcome Assessment of an ABC-Based HIV Peer Education Intervention Among Kenyan University Students
This study reports on an outcome assessment of an HIV peer education program initiated in 2004 on the main campus of Kenyatta University in Nairobi, Kenya. The program is being implemented by I Choose Life-Africa (ICL), a local nongovernmental organization. ICL’s early programs focused primarily, though not exclusively, on abstinence messages and other activities such as purity pledges. More recently, abstinence plus activities have been adopted, including advocating for general sexual responsibility, faithfulness, and condom use. After two years of on-campus ABC-based HIV peer education programming, no changes in behavior were evident with respect to either abstinence or number of sexual partners. Small but statistically significant changes were found in condom attitudes and behavior, and a large increase in HIV testing was evident. The authors contend that the effectiveness of peer education is likely to vary depending on contextual and cultural factors related to a given activity. However, the lack of a shift of abstinence and faithfulness indicators in this study raises questions about the ability of peer education to promote behavior change through a comprehensive ABC message. The authors advocate that future studies should compare abstinence-only approaches with full ABC programming.
Impact evaluation of the African Youth Alliance in Ghana, Tanzania, And Uganda: Implications for Future Youth Programming
In 2005, the JSI Research and Training Institute, Inc. evaluated the impact of The African Youth Alliance (AYA) program, established in 2000 by the Bill & Melinda Gates Foundation and implemented by the United Nations Population Fund, Pathfinder International, and the Program for Appropriate Technology in Health. The evaluation measured whether exposure to AYA’s comprehensive, integrated HIV prevention program resulted in improved adolescent and sexual reproductive health (ASRH), knowledge, attitudes, and sexual behaviors among male and female youth ages 17 to 22 in Ghana, Tanzania, and Uganda. Results demonstrated a significant positive impact on knowledge generation, condom use, contraceptive use, partner reduction, and several self-efficacy and knowledge antecedents. The program had less of an effect on male responsibility, sexual debut, and/or abstinence and partner reduction. Results suggest that a comprehensive, scaled-up, multi-component HIV prevention approach can be effective in improving some key ASRH outcomes.
The impact of Life Skills Education on Adolescent Sexual Risk Behaviors in KwaZulu-Natal, South Africa
A middle and high school-based Life Skills Program for ages 14 to 24 was conducted in South Africa’s KwaZulu-Natal Province. The curriculum addressed 11 sexual and reproductive health-related life skills topics, ranging from drugs and alcohol to negotiation and assertiveness in relationships. Baseline and two-year follow-up data from 2,222 youth assessed the program’s impact on HIV-related knowledge, attitudes, and behaviors. Knowledge gains were generally minimal and uneven across the topics. The largest changes observed in sexual behaviors were for condom use at first and last sex. Minimal gains were observed for sexual health knowledge and reported self-efficacy to get and use a condom. The proportion of youth who had initiated sexual activity increased by nearly half, though it is important to note that the youth were two years older than at baseline; no change in age at sexual initiation was noted. There were no major effects on age at sexual initiation, secondary abstinence, or number of partners. While school-based life skills programs have the potential of helping youth reduce HIV risk, the long-term benefits of a national education program are unknown.
The United States President’s Emergency Plan for AIDS Relief (PEPFAR) Guidance, Abstinence, Be Faithful, and Correct and Consistent Condom Use (ABC)
This site offers six links to PEPFAR’s ABC approach, including an introduction, defining the ABC approach, and implementing the ABC approach. There are also two appendices: one is on how to determine the appropriate mix of ABC activities and the other is a list of references. The last link is to the original ABC Guidance Number One, which is in PDF format. These documents are designed to provide guidance to the field and missions to implement ABC programs.
Preventing HIV/AIDS in Young People: A Systematic Review of the Evidence from Developing Countries
This report documents the findings from key studies on youth-based HIV prevention programs organized into categories, depending on whether the evidence is strong enough to recommend the program. The report includes recommendations for policymakers, program development and delivery staff, and researchers. Both chapters five and seven examine the effect of these activities on abstinence as one of the outcomes (Chapter Five: “The effectiveness of sex education and HIV education interventions in schools in developing countries,” and Chapter Seven: “The effectiveness of mass media in changing HIV/AIDS related behavior among young people in developing countries”). These results, by study, are concisely summarized in tables.
The Less They Know, the Better: Abstinence-only HIV/AIDS Programs in Uganda
This article assesses the “ABC” approach that has been heralded as a success in Uganda. Specifically, it cautions that abstinence-until-marriage messages fail to educate young people about accurate HIV and sexually transmitted infection risks and prevention options, and thus violates human rights principles. The authors present a series of recommendations for the Government of Uganda, the United States Government, and all other donors to Uganda AIDS programs. The recommendations focus on supporting effective HIV prevention programming, including encouraging youth to delay sex as part of a comprehensive approach to HIV prevention. The authors discourage use of ideology-based messages, e.g., abstinence-until-marriage, that do not incorporate scientifically effective HIV prevention methods, including condoms, and accurate information about HIV risks.
Abstinence, Fewer Partners, and Condom Use are Complementary Messages
The first phase of a major six-country study suggests that promotion of sexual abstinence to prevent HIV infection contributed to an approximately one-year delay of sexual initiation among youth in two countries, Uganda and Zambia, where HIV prevalence declined throughout the 1990s.
Preventing HIV with Young People: A Case Study from Zambia
This case study examines how Abstinence and Being Faithful programs for youth are being implemented in Zambia. They found that the majority of implementing agencies are supporting abstinence-only activities and have not challenged the overall prevention strategy. Many programs are providing erroneous information about condoms and refuse to distribute them. The authors caution against stigmatizing condoms and those who use them, and encourage all HIV/AIDS programmers to provide a wide range of prevention options to the target populations based on their needs.