title: Abstinence Funding Was Not Associated With Reductions In HIV Risk Behavior In Sub-Saharan Africa.
abstract: The President's Emergency Plan for AIDS Relief (PEPFAR) has been the largest funder of abstinence and faithfulness programming in sub-Saharan Africa, with a cumulative investment of over US $1.4 billion in the period 2004-13. We examined whether PEPFAR funding for abstinence and faithfulness programs, which aimed to reduce the risk of HIV transmission, was associated with a relative change in five outcomes indicative of high-risk sexual behavior: number of sexual partners in the past twelve months for men and for women, age at first sexual intercourse for men and for women, and teenage pregnancies. Using nationally representative surveys from twenty-two sub-Saharan African countries, we compared trends between people living in countries that received PEPFAR abstinence and faithfulness funding and those living in countries that did not in the period 1998-2013. We found no evidence to suggest that PEPFAR funding was associated with population-level reductions in any of the five outcomes. These results suggest that alternative funding priorities for HIV prevention may yield greater health benefits.
authors.affiliation: Nathan C. Lo (nathan.lo@stanford.edu) is an MD-PhD candidate at Stanford University School of Medicine, in California.
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Lo
authors.affiliation: Anita Lowe is a medical student at Stanford University School of Medicine.
authors.forename: Anita
authors.initials: A
authors.lastname: Lowe
authors.affiliation: Eran Bendavid is an assistant professor in the Department of Medicine at Stanford University School of Medicine.
authors.forename: Eran
authors.initials: E
authors.lastname: Bendavid
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006291:Health Policy / Q000191:economics*; D006306:Health Surveys; D006801:Humans; D007391:International Cooperation; D008297:Male; D015397:Program Evaluation / Q000191:economics; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data*
keywords: AIDS/HIV; Developing World < International/global health studies; Health Promotion/Disease Prevention; Public Health