Abstinence promotion under PEPFAR: The shifting focus of HIV prevention for youth

Abstract

Abstinence-until-marriage (AUM) – strongly supported by religious conservatives in the USA – became a key element of initial human immunodeficiency virus (HIV) prevention efforts under the President's Emergency Plan for AIDS Relief (PEPFAR). AUM programmes have demonstrated limited efficacy in changing behaviours, promoted medically inaccurate information and withheld life-saving information about risk reduction. A focus on AUM also undermined national efforts in Africa to create integrated youth HIV prevention programmes. PEPFAR prevention efforts after 2008 shifted to science-based programming, however, vestiges of AUM remain. Primary prevention programmes within PEPFAR are essential and nations must be able to design HIV prevention based on local needs and prevention science.

Keywords:

• HIV
• PEPFAR
• abstinence
• youth
• prevention

Acknowledgements

The authors are grateful to Elizabeth Lagone and Ashley Schuyler for aiding in the preparation of this manuscript. Dr Zoe Edelstein is supported by a NIMH training grant (T32-MH19139 Behavioral Sciences Research in HIV Infection; PI: Theo Sandfort, Ph.D.). The content is solely the responsibility of the authors and does not necessarily represent the official views of National Institute of Mental Health or the National Institutes of Health.