There is no evidence that HIV prevention programs that promote sexual abstinence and fidelity are effective at either changing sexual behavior or reducing HIV risk, according to a study published in Health Affairs.

Since 2004, the U.S. government has invested $1.4 billion to fund these programs in sub-Saharan Africa through the U.S. President’s Emergency Fund for AIDS Relief (PEPFAR). Although the program has gradually been reducing the amount of funding it provides to abstinence programs, the annual funding is still approximately $50 million.

“Spending money and having no effect is a pretty costly thing because the money could be used elsewhere to save lives,” said Eran Bendavid, MD, an assistant professor of medicine at Stanford University.

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The study included nationally representative surveys of approximately 500,000 participants in 22 countries in sub-Saharan Africa, 14 of which were PEPFAR-funded. The researchers collected data regarding 5 outcomes related to high-risk sexual behavior: number of sexual partners in the past 12 months for men and women, age of first sexual intercourse for men and women, and teenage pregnancies. They looked for trends in these outcomes from 1998 to 2013, comparing countries that received PEPFAR abstinence and faithfulness funding and those that did not.

The researchers did not find any evidence that PEPFAR funding was associated with population-level reductions in any of the 5 study outcomes.

“We hope our work will emphasize the difficulty in changing sexual behavior and the need to measure the impact of these programs if they are going to continue to be funded,” said Nathan Lo, an MD/PhD student at Stanford University.


  1. Lo NC, Lowe A, Bendavid E. Abstinence funding was not associated with reductions in HIV risk behavior in sub-Saharan Africa. Health Affairs. 2016;35(5):856-863.