Excerpted from Confronting the Evidence in Evidence-Based Prevention: Current Scientific and Political Challenges by Judith D. Auerbach, PhD and William Smith

Even where scientific consensus exists about what constitutes good evidence for making policy decisions, it often is ignored or challenged by people with ideological agendas that run counter to the evidence. Such challenges have intensified over the past eight years. The promotion of abstinence-only-until-marriage sex education and the opposition to syringe exchange programs are perhaps the keenest examples.

Abstinence-Only-Until-Marriage Programming

Over the past quarter century, nearly 1.5 billion federal tax dollars have been allocated to the abstinence-only-until-marriage approach to the prevention of HIV, other sexually transmitted diseases, and unintended pregnancy. Since 1998, the U.S. government has offered every state the opportunity to apply for grants (totaling $50 million per year) that have as their “exclusive purpose teaching the social, psychological, and health gains to be realized by abstaining from sexual activity.” These programs are prohibited from discussing condoms or contraception, except to emphasize their failure rates; the “exclusive purpose” clause prevents communication of any other risk-reduction messages—including discussion of condoms, a known effective HIV prevention tool.

In 2001, social conservatives secured additional federal funds to create the Community-Based Abstinence Education program, which provides direct competitive grants for abstinence-only-until-marriage programs. What began as a $20 million per year program has grown by 450%, reaching a current total of $113 million. President Bush has proposed increasing this funding stream to $141 million for Fiscal Year 2008.

These programs are conducted in diverse settings, from schools to county health departments to right-wing-operated “crisis pregnancy centers.” Few venues that are considered essential to conducting sound, evidence-based health education have escaped the explosion in abstinence-only-until-marriage funding. Furthermore, the U.S. government has exported these programs to resource-limited countries most affected by HIV/AIDS; U.S. funding for international programs that promote the so-called “ABC” approach to HIV prevention—“abstain, be faithful, use condoms”—favors the “A” and the “B” over the “C” in both policy and dollars (see sidebar below).

Despite the exponential growth in abstinence-only-until-marriage funding and programming at the state, federal, and international levels, evidence from program evaluations simply does not support the approach. Most recently, a large federally funded study found no evidence that abstinence-only-until-marriage programs have achieved their goal of increasing rates of sexual abstinence—the explicit purpose of the programs.

The study, commissioned by the U.S. Department of Health and Human Services, enrolled more than 2,000 children and teenagers in four states, and found that youth in the abstinence-only-until-marriage program group were no more likely than those in the control group to have abstained from sex: 49% in each group remained abstinent. In addition, those who reported being sexually active had a similar average age at sexual debut (14.9 years) and similar numbers of sexual partners in the program and control groups.

These findings have sparked a welcome debate. On April 23, 2008, concerned policy makers and medical experts testified during the first-ever Congressional hearing on the effectiveness of federally funded abstinence-only-until-marriage programs, held by the U.S. House of Representatives Committee on Oversight and Government Reform and led by Chairman Henry Waxman (D-CA). Witnesses spoke of medically inaccurate information provided by program materials, pressure to sign “virginity pledges” in front of peers, and the alarmingly high numbers of teenage girls with sexually transmitted infections—one in four, according to CDC. “Continuing funding for ineffective abstinence-only programs makes no sense,” said Congresswoman Barbara Lee (D-CA), author of the Responsible Education about Life (REAL) Act, which would initiate federal funding for comprehensive sex education.

The flaws in abstinence-only-until-marriage programs have not escaped states’ attention. Seventeen states currently do not participate in the grant program, and to date, 13 states have conducted evaluations of their federally funded abstinence-only-until-marriage programs; not a single one has found the programs to be a good investment. By focusing on the lack of evidence to support abstinence-only-until-marriage programming as a viable HIV prevention tool, advocates have raised the standard of evidence for more comprehensive behavioral interventions.