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'Unscientific' HIV abstinence programmes continue in US

The US House of Representatives votes for major extensions of the administration's abstinence education programmes, despite evidence that they do not prevent HIV transmission

The US House of Representatives has voted for major extensions of the administration's abstinence education programmes, despite evidence that they do not prevent HIV transmission. 

In July 2007, the full House passed the FY08 Health and Human Services (HHS) budget, which included a USD 28m (25 per cent) increase in community-based abstinence-only education grants.

The Senate Appropriations Committee version of the budget specifies a USD 28m cut instead. The two versions will have to be reconciled in the fall. Also, rather than terminate the Title V grants to states for abstinence-only education, as widely expected, the House voted to extend them for another two years. The Title V grants total USD 50m per year from the federal government, as well as USD 37.5m contributed by the states which distribute them.

As a compromise, the House loosened the restrictions on the Title V grants so they can now go to a programme "which promotes abstinence and educates those who are currently sexually active or at risk of sexual activity about additional methods to prevent unintended pregnancy or reduce other health risks."

In contrast, the appropriation bill language defining the community-based grants continues to specifically exclude grantees from providing "any other education regarding sexual conduct."

The new Title V language also demands that the programmes provide only information not "unsupported or contradicted by the preponderance of the peer-reviewed scientific literature." It then goes on to restrict the grants to programmes "based on a model that has been demonstrated to be effective in preventing unintended pregnancy, or in reducing the transmission of a sexually transmitted disease, including the human immunodeficiency virus."

There are no programmes which currently meet this standard. At most, abstinence programmes have been found to reduce teens' sexual activity for a year or two, without an effect on STD rates, according to a study conducted by Adolesc Health in 2005. If the law were strictly enforced, nobody would qualify for the grants.

The Bush administration will be the final arbiters of the grant process. There are 39 states which now accept Title V grants under HHS's strict abstinence-only guidelines. In the past, these bodies haven't been troubled much by scientific accuracy or evidence of effectiveness.

The new law may provide a new venue for debating abstinence education's merits, but it is difficult to see any change over the next two years in the way the Title V grants are administered, not to mention the larger community-based programme.

30th September 2008

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