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Abstract
Systematic review of the impact of abstinence-only programmes on risk behavior in developing countries (1990-2005)
K. O'Reilly1, A. Medley2, J. Dennison2, M. Sweat2
1World Health Organization, HIV/AIDS, Geneva, Switzerland, 2Johns Hopkins Bloomberg School of Public Health, International Health, Baltimore, MD, United States
Background: Abstinence-only programmes have gained attention in recent years and and increasingly promoted and funded in developing countries. Is there evidence that these programmes are effective in these settings? This abstract updates our past systematic review to include five new abstinence studies published up to April 2005.
Methods: A standardized protocol for searching, acquiring, extracting study data, and synthesizing results across studies was used. Inclusion criteria included: (1) post intervention / evaluation data and multi-arm study design or pre-post assessment of outcomes, (2) set in developing country, (3) intervention that encouraged abstinence, (4) intervention focused on HIV prevention and (5) behavioural, psychological, social, care or biological outcome presented. Data were extracted by 2 coders with differences resolved by a 3rd coder.
Results: 12 papers from 9 studies were identified. Designs were 3 randomized controlled trials, 4 pre/post studies, 1 non-randomized control trial and 1 post-intervention only assessment. Significant but mostly modest effects were found for knowledge, beliefs and intentions to delay sex or to use condoms if they engaged in sex. Little or no evidence of effect on actual behaviour was found.
Conclusions: Even with the inclusion of new studies since our last synthesis, little evidence of the effectiveness of abstinence-only programmes in developing countries was found, either because of weak study designs or the difficulty in measuring outcomes of interest. Most evidence of effectiveness related to changes in beliefs. However encouraging changes in beliefs may be, they cannot be assumed to result in complete abstinence or other safer sexual behaviour.
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