Back in the 1990s and early 2000’s, when I was doing a lot of research on the politics of AIDS policy, it sure seemed hard to believe that billboards, classes, and other initiatives telling people in Africa to abstain from sex would actually cause anyone to abstain from sex. And alas, new research shows that all of this money — that might have been spent on AIDS treatment or on anything else — was squandered.
Billboard asks Ugandans to abstain from sex until marriage. The photo was taken in 2005 in Kampala. (via NPR: Per-Ander Pettersson/Getty Images)
The money was part of the President’s Emergency Plan for AIDS Relief. It went to sex ed classes and public health messages in Africa. Effective or not? A new study offers a clear verdict.
Evan: Is it possible that the efficacy of the abstinence programs is, in part, asking the wrong question? One of the main explanations why PEPFAR was, and remains, so hugely popular is that it was based on a broad bipartisan coalition that included people on part of the spectrum that needed abstinence to be part of it for political reasons. Without them, perhaps, PEPFAR would have been much smaller, likely much less than the amount “lost” to abstinence programming. Should we think of it as a tax on the political bargain that enabled it in the first place? I’m not sure I’m right, but it’s a hypothesis.
Todd: Good point. I definitely think it is fair to think about the abstinence program as a “tax” to achieve the political bargain of getting the Bush administration and various conservative interests to support the larger PEPFAR program, which has certainly helped to put millions on treatment and to extend the lives of those living with HIV.
That said, for those who supported abstinence programs — both in the U.S. and in Africa — I assume they thought that this kind of behavior change was possible. So the sad part is simply the amount of money that was spent on a failed policy, irrespective of whether you predicted it was promising from the outset. (If the results had showed that the program markedly delayed the age of sexual debut and decreased HIV incidence, I would have been delighted with the results, while conceding that I was wrong to doubt the program.)
I would hope that if such a proposal were vetted today, someone in the administration would demand some rigorous evidence demonstrating that an abstinence program could at least increase the likelihood of abstinence before scaling up so large.