The U.S. PEPFAR Program Spent $1.4 Billion To Stop HIV By Promoting Abstinence. Did It Work? : Goats and Soda 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.

U.S. Spent $1.4 Billion To Stop HIV By Promoting Abstinence. Did It Work?

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In the past 12 years, the U.S. has spent over $1.4 billion funding abstinence programs in Africa. They're part of a larger program called PEPFAR aimed at stopping the spread of HIV around the world. PEPFAR is credited with giving lifesaving HIV drugs to more than five million people, but a study out this week finds the abstinence programs have been a failure. NPR's Michaeleen Doucleff explains.

MICHAELEEN DOUCLEFF, BYLINE: In 2003, President George W. Bush proposed an unprecedented program. It was called the President's Emergency Plan for AIDS Relief, or PEPFAR. The program would give billions of dollars to treat people for HIV in Africa. No one had ever given this much money to treat a single disease. Congress funded the program with bipartisan support. But one part of the plan was controversial. A third of the money going towards HIV prevention was earmarked for abstinence before marriage programs, like teaching abstinence in schools, also with billboards and radio messages. Right away these programs drew criticism.

JOHN DIETRICH: I think there was definitely a fear from certain sectors that the United States and the Western community therefore was making decisions based on either their own experiences or their own moral values and not fully taking into consideration the values at the other end.

DOUCLEFF: That's John Dietrich, an assistant professor of political science at Bryant University and a foreign policy expert. He says the earmark was added to please certain Republicans.

DIETRICH: Who wanted to make sure that money wouldn't be spent on anything that might be seen as promoting teenage sex or any other promiscuity.

DOUCLEFF: Dietrich says it was a political move, especially because there was little evidence these abstinence programs would work. Studies in the U.S. pretty much showed that telling teens not to have sex didn't prevent teenage pregnancies or decrease high-risk sexual behavior.

But there hadn't been similar studies in Africa. Eran Bendavid is an infectious disease doctor at Stanford University. He says Uganda had early success at slowing HIV.

ERAN BENDAVID: The thought was that this was a result of a successful campaign that came from the government that had to do with what people called ABC - abstinence, be faithful and condomise.

DOUCLEFF: But no one knew which component was responsible. So Bendavid, who led the study published this week in Health Affairs, wanted to see if abstinence programs helped. His team analyzed surveys given to nearly a half a million people in 22 African countries. The surveys asked personal questions, like how many sexual partners do you have and at what age did you first have sex? Some of the countries received PEPFAR money; some didn't.

The results were clear - PEPFAR's funding had no detectable effect on young people's choices about sex. Bendavid says he's not too surprised by the results. He says it takes more than billboards or radio messages to change people's behavior.

BENDAVID: I think that the decisions about sexual behavior and sexual preferences are much deeper. They're much more - so deeply rooted.

DOUCLEFF: In 2008, President Obama removed the requirement that PEPFAR fund abstinence programs. Since then, funding has steadily declined. Today, the U.S. government spends about $40 million a year on these programs in Africa and Asia. We asked the head of PEPFAR if this new study would lead to an even bigger decrease. Ambassador Deborah Birx declined to be interviewed. In a statement, the agency said PEPFAR bases its HIV interventions on the latest scientific evidence and has found a combination of approaches is most effective. Michaeleen Doucleff, NPR News.

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