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Study Finds that Some “Abstinence-Plus” Programs have Positive Effects on Sexual Behavior


In a follow up effort to their recent study on the impact of abstinence-only-until-marriage programs on HIV prevention among young people, researchers released this study assessing the impact of abstinence-plus programs on HIV prevention and related behavior among young people.  For this study, the authors examined existing research on trials that compared students in abstinence-plus program to at least one control group.  “Abstinence-plus,” as defined in the study, was a program that encouraged sexual abstinence as the most effective means of HIV prevention, but also taught condom use and partner reduction.  As in the earlier study, researchers examined programs in high income countries (income per capita of at least $10,726).
For this study, researchers identified 39 trials including approximately 37,724 North American youth as either members of an abstinence-plus program or a control group.    The trials examined took place at schools, community centers, health care facilities, and at home.   


K. Underhill, et al., (2007), “Systematic Review of Abstinence-Plus HIV Prevention Programs in High-Income Countries.”  PLOS Med 4.9 (2007): e275.

Key Findings:

  • The majority of the abstinence-plus programs studied showed increased knowledge about HIV/AIDS (83% of studies) and increased condom use (54% of programs).
  • 23 out of the 39 trials found a protective program effect on at least one sexual behavior among those enrolled in the abstinence-plus groups.
  • 14 of the 26 trials that measured condom use showed a significant protective effect in the abstinence-plus groups.
  • 20 of the 24 trials that measured HIV/AIDS knowledge showed that participants in the abstinence-plus program reported significantly greater HIV/AIDS knowledge than participants in the control groups.
  • 2 of the 3 trials that measured incidence of unprotected vaginal intercourse found significant protective effects in the abstinence-plus groups at the 12 month follow up.
  • 6 of the 12 trials that measured frequency of unprotected vaginal sex found significant protective effects in the abstinence-plus groups. 
  • 2 of the 3 trials that reported incidence of anal sex found a protective effect in the abstinence-plus groups.
  • 4 of the 13 trials that assessed participants’ number of sexual partners found a significant protective effect in the abstinence-plus groups.

SIECUS Analysis:
The results of this study show promise in abstinence-plus programs, with 23 of the 39 trials showing a statistically significant protective effect on at least one sexual behavior.  In addition, none of the abstinence-plus programs looked at showed any negative effects on young people.

This study suggests that programs that teach about abstinence and contraception can be an effective tool for educating young people about important sexual health issues.  

Close examination of the findings can help put advocates and educators in a better position to understand the characteristics of programs that positively impact behavioral changes.