Community support for abstinence can assist in HIV prevention

The Guttmacher Institute just published a report looking at community influences on the sexual activity of young people in a province of Kenya, and found that in communities that used abstinence education as the main HIV prevention message, young men were more likely to delay sexual activity.  Additionally, young people were more likely to abstain when AIDS was acknowledged as a cause of deaths in the community – when the connections between sexual activity, HIV/AIDS, and death are publicly admitted, young people experience less pressure toward early sexual activity and feel more empowered to abstain from it.

The issue of delaying sexual debut among young people recently became a contentious issue at the UN during the Commission on the Status of Women.  The document under consideration was about prevention of HIV/AIDS among women and girls in Africa.  The Friday Fax reported:

“In a surprise move, the Dutch delegate intervened to amend the resolution on behalf of the US and other countries in Europe and Latin America. They could not accept a mention of “delay of sexual debut” in a paragraph on helping women and girls protect themselves from HIV. Among the other defenses against HIV left in were condoms, gender equality, and gender sensitivity.”

In contrast, the Guttmacher report refers to delayed sexual debut as a “positive behavioral outcome” and acknowledges that it “is an important HIV prevention strategy.”

Pointing out that most previous studies on the timing of sexual debut focus on individual-level rather than community-level variables, the authors look for correlations between the age of sexual initiation and practices and norms within the broader community.

Among the factors correlated with delayed sexual debut:

• Abstinence being taught to youth as the primary AIDS prevention message

• Young men with greater “abstinence self-efficacy”

• Public acknowledgment of AIDS as the cause of deaths within the community

“Self-efficacy” referred to young men expressing the belief that they could say no to sex and planned to do so in the future.  This finding is particularly important given the context of what is commonly referred to as “comprehensive sexuality education” (CSE) in UN documents.  C-FAM recently published a briefing paper by a group of Spanish experts who point out that the curricula favored by CSE proponents “usually rely heavily upon the concept of “risk reduction” [condoms] since they assume “risk avoidance” [abstinence] is not possible.”

Empowering young men to believe that abstinence is both possible and beneficial leads to later sexual initiation, which in turn is linked to having fewer sexual partners and a reduced risk of contracting HIV.  The same report found that “condom self-efficacy”, or a sense of empowerment to use condoms during sex, was not significantly associated with delayed sexual debut.  If anything, reliance on condoms could have a perverse effect:

“Earlier debut was associated with reporting a larger number of sources of pressure to have sex and with living in a community where HIV programming was part of community festivals (typically in the form of condom distribution).”

As these results show, young people are capable of making informed decisions, but they do not do so in a vacuum – the values and priorities of the broader community play an important role in encouraging and empowering them to do so.  This is particularly critical in HIV-ravaged sub-Saharan Africa, where a tyranny of low expectations around sexual behavior can have deadly consequences.

Reprinted with permission from TurtleBayandBeyond.org.