How Not to Spend $1.4 Billion

From a recent article in HealthAffairs:

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. […]

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 [tested outcomes indicative of risky sexual behavior].

In other words: For most people, abstinence sucks and telling them that it’s cool doesn’t change their minds, even if you spend $1.4 billion on it. Not very surprising, because as NPR notes:

At the time, there was little evidence to suggest abstinence programs work. Randomized-control trials in the U.S. had shown that abstinence education programs didn’t prevent teenage pregnancies or decrease high-risk sexual behavior.

The results of the study are pretty damming:

PEPFAR funding wasn’t associated with changes in young people’s choices about sex. Bendavid and his team could find no detectable differences in the rates of teenage pregnancies, average number of sexual partners and age at first sexual intercourse in countries that had received PEFPAR money compared with those that hadn’t.

As the NPR story points out, PEPFAR is credited with saving millions of lives by providing HIV drugs and preventing HIV transmissions from mothers to newborns. That work is commendable. But it makes me sad to think about how many more lives could have been saved, if some conservative politicians wouldn’t have insisted on spending a ridiculous amount of money on programs that had little hope of achieving the desired outcomes, simply because they hoped to push their opinion about the right way to have sex on others.