1. Abstinence education, SRE, HIV prevention and condoms Simon Forrest

2. Abstinence v. Comprehensive SRE Abstinence education focuses on teaching young people that abstaining from sex until marriage and being faithful to their marriage partner thereafter is the best means of ensuring that they avoid infection with HIV, other sexual transmitted infections and unintended pregnancy Abstinence education focuses on teaching young people that abstaining from sex until marriage and being faithful to their marriage partner thereafter is the best means of ensuring that they avoid infection with HIV, other sexual transmitted infections and unintended pregnancy Comprehensive SRE includes emphasising the potential benefits of delaying having sex and educating in the use of contraception to avoid infections and pregnancy. Comprehensive SRE includes emphasising the potential benefits of delaying having sex and educating in the use of contraception to avoid infections and pregnancy.

3. A Rapprochment?: Abstinence Plus [1]. [1] Abstinence plus places the main emphasis on abstaining from sex as the preferred choice of protection but young people are provided with information about contraception and disease prevention so that they can protect themselves when they do become sexually active [2]. Abstinence plus places the main emphasis on abstaining from sex as the preferred choice of protection but young people are provided with information about contraception and disease prevention so that they can protect themselves when they do become sexually active [2]. [2] [1] Halperin, D. T., Steiner, M. J., Cassell, M. M. et al. (2004) The time has come for common ground on preventing sexual transmission of HIV, The Lancet 364: 1913- 1915. [1] Halperin, D. T., Steiner, M. J., Cassell, M. M. et al. (2004) The time has come for common ground on preventing sexual transmission of HIV, The Lancet 364: 1913- 1915.[1] [2][2] The Henry J. Kaiser Family Foundation (2003) Sex Education in the US: Policy and Politics, http://www.kff.org/youthhivstds/3224-02-index.cfm [2]

4. Conflict of ideology Moral basis for views Moral basis for views (Condoms) (Condoms) Theoretical Theoretical (Mixed messages) (Mixed messages)

5. Negative or positive attitudes towards sex and sexuality

6. Contentions Against comprehensive approaches: Against comprehensive approaches: Too positive about effectiveness of condoms; Too positive about effectiveness of condoms; Sending mixed messages Sending mixed messages Against abstinence approaches: Against abstinence approaches: Understate/misrepresent the effectiveness of condoms; Understate/misrepresent the effectiveness of condoms; Reinforcing negative gender and sexual stereotypes Reinforcing negative gender and sexual stereotypes Representing sex too negatively Representing sex too negatively

7. Evidence (against comprehensive) Rector, R. (2002) The Effectiveness of Abstinence Education Programs in Reducing Sexual Activity Among Youth, The Heritage Foundation Policy Research and Analysis, http://www.heritage.org/Research/Family/BG1533.cfm Condoms offers relatively little protection (from "zero" to "some") for herpes and no protection from the deadly HPV. A review of the scientific literature reveals that, on average, condoms failed to prevent the transmission of the HIV virus-- which causes the immune deficiency syndrome known as AIDS--between 15 percent and 31 percent of the time. [3] [3] Weller, S. (1993) "A Meta-Analysis of Condom Effectiveness in Reducing Sexually Transmitted HIV," Social Science and Medicine, 36(12) National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, "Summary," Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention, July 20, 2001.

8. Evidence (against abstinence) White, C. (2004) Group suggestions for introduction to True Love Waits, Nashville: Lifeway Press (http://www.lifeway.com/tlw/downloads/pdf_IntroTLWGroup.pdf)

9. Evidence (against abstinence) …. contain factual inaccuracies, such as massively overestimating the prevalence of HIV and STIs, the failure rates of condoms when properly use and marginalising the needs of lesbian, gay and bisexual young people by focusing on marriage [1]. These reviews and other critical evaluations of abstinence curricula have also shown that they tend to project stereotypes about gender, repress information about positive aspects of sexual relationships and overstate the emotional risks and dangers associated with sex [2] …. contain factual inaccuracies, such as massively overestimating the prevalence of HIV and STIs, the failure rates of condoms when properly use and marginalising the needs of lesbian, gay and bisexual young people by focusing on marriage [1]. These reviews and other critical evaluations of abstinence curricula have also shown that they tend to project stereotypes about gender, repress information about positive aspects of sexual relationships and overstate the emotional risks and dangers associated with sex [2] [1] [2] [1] [2] [1] Batchler, M (2004) Keeping our Youth ‘Scared chaste’ SIECUS Curriculum Review: Choosing the best life A fear-based abstinence-only-until-marriage program for high school students, http://www.siecus.org/reviews.html [1] Batchler, M (2004) Keeping our Youth ‘Scared chaste’ SIECUS Curriculum Review: Choosing the best life A fear-based abstinence-only-until-marriage program for high school students, http://www.siecus.org/reviews.html [1] [2] Blake, S. and Frances, G.(2001) Just say no to abstinence education, National Children's Bureau, 2001 [2] Blake, S. and Frances, G.(2001) Just say no to abstinence education, National Children's Bureau, 2001 [2]

10. Evidence (against abstinence) The age at which people first marry is around 30 years old The age at which people first marry is around 30 years old a fifth of marriages end in divorce or separation within five years [1],[2]. a fifth of marriages end in divorce or separation within five years [1],[2]. [1][2] [1][2] Age at first sexual intercourse is around 16 years old and a diminishing minority of people report that their first sexual partner was also their marriage partner [3],[4]. Age at first sexual intercourse is around 16 years old and a diminishing minority of people report that their first sexual partner was also their marriage partner [3],[4]. [3][4] [3][4] [1] National Centre for Health Statistics (2004) Marriage and Divorce (data for US 2003) http://www.cdc.gov/nchs/fastats/divorce.htm [1] National Centre for Health Statistics (2004) Marriage and Divorce (data for US 2003) http://www.cdc.gov/nchs/fastats/divorce.htm [1] [2] National Statistics (2005) Marriages, 1846-2002: median age at marriage by sex and previous marital status, http://www.statistics.gov.uk/STATBASE/xsdataset.asp?More=Y&vlnk=5277&All=Y&B 2.x=36&B2.y=9 [2] National Statistics (2005) Marriages, 1846-2002: median age at marriage by sex and previous marital status, http://www.statistics.gov.uk/STATBASE/xsdataset.asp?More=Y&vlnk=5277&All=Y&B 2.x=36&B2.y=9 [2] [3] [3] Wellings K, et al. Sexual behaviour in Britain: early heterosexual experience. The Lancet 2001; 358 1843-1850 [3] [3] Wellings K, et al. Sexual behaviour in Britain: early heterosexual experience. The Lancet 2001; 358 1843-1850 [3] [4] Hubert, M., Bajos, N., and Sandfort, T. (1998) Sexual behaviour and HIV/Aids in Europe, London: University College London Press [4] Hubert, M., Bajos, N., and Sandfort, T. (1998) Sexual behaviour and HIV/Aids in Europe, London: University College London Press [4]

11. Effects and effectiveness Comprehensive sex education works: Comprehensive sex education works: Collins, C., Alagiri, P. and Summers, T. (2002) Abstinence only vs. comprehensive sex education: What are the arguments? What is the evidence? University of California, San Francisco: AIDS Research Institute Collins, C., Alagiri, P. and Summers, T. (2002) Abstinence only vs. comprehensive sex education: What are the arguments? What is the evidence? University of California, San Francisco: AIDS Research Institute Kirby, D., Short, L., Collins, J., Rugg, D., Kolbe, L., Howard M et al. (1994) School-based programmes to decrease sexual risk behaviours: a review of effectiveness, Public Health Report 109 pp.336-360 Kirby, D., Short, L., Collins, J., Rugg, D., Kolbe, L., Howard M et al. (1994) School-based programmes to decrease sexual risk behaviours: a review of effectiveness, Public Health Report 109 pp.336-360 Dickson, R., Fullerton, D., Eastwood, A., Sheldon, T., Sharp, F et al. (1997) Effective Health Care: Preventing and reducing the adverse effects of unintended teenage pregnancies, National Health Service Centre for Reviews and Dissemination University of York Dickson, R., Fullerton, D., Eastwood, A., Sheldon, T., Sharp, F et al. (1997) Effective Health Care: Preventing and reducing the adverse effects of unintended teenage pregnancies, National Health Service Centre for Reviews and Dissemination University of York Dicenso A, Guyatt G, Willan A et al. (2002) Interventions to reduce unintended pregnancies among adolescents: systematic review of randomised controlled trials. British Medical Journal, 324 1426-1435 Dicenso A, Guyatt G, Willan A et al. (2002) Interventions to reduce unintended pregnancies among adolescents: systematic review of randomised controlled trials. British Medical Journal, 324 1426-1435 Dennison, C. (2004) Teenage Pregnancy: An overview of the research evidence. London: Health Development Agency Dennison, C. (2004) Teenage Pregnancy: An overview of the research evidence. London: Health Development Agency Swann, C., McCormick, G. and Kosmin, M. (2003) Teenage Pregnancy and Parenthood: A Review of Reviews. London: Health Development Agency Swann, C., McCormick, G. and Kosmin, M. (2003) Teenage Pregnancy and Parenthood: A Review of Reviews. London: Health Development Agency

12. Effects and effectiveness There is no evidence that abstinence education works (although a trial is underway) [1] There is no evidence that abstinence education works (although a trial is underway) [1] Pledges may lead to later first sexual intercourse (but only for young people who already have strong faith beliefs and who form a select group) [2] Pledges may lead to later first sexual intercourse (but only for young people who already have strong faith beliefs and who form a select group) [2] Others tend to have more risky sex and use condoms less. [3] Others tend to have more risky sex and use condoms less. [3] [1]Mathematica Policy Research Inc. (2005) The Evaluation of Abstinence Education Programs Funded Under Title V, Section 510, http://www.mathematica- mpr.com/welfare/abstinence.asp [2] Bearman, P. and Bruckner, H. (2001) Promising the Future: Virginity pledges and first intercourse, American Journal of Sociology 106(4): 859-912. [3] Bruckner, H. and Bearman, P. (2005) After the promise: the STD consequences of adolescent virginity pledges, Journal of Adolescent Health 36: 271-278

13. USA $170 million is being granted by Congress to abstinence education in 2005 and the President seeking to increase this to $206 million in 2006[1] $170 million is being granted by Congress to abstinence education in 2005 and the President seeking to increase this to $206 million in 2006[1][1] Matched funding for programmes which [2] … Matched funding for programmes which [2] … [1][1] Sexuality Information and Education Council of the United States (2005) SIECUS State Profile: A Profile of sexuality education and abstinence-only-until-marriage programs in the States, http://www.siecus.org/policy/states/index.html. http://www.siecus.org/policy/states/index.html [1] http://www.siecus.org/policy/states/index.html [2] Maternal and Child Health Bureau, US Department of Heath and Human Service: Health Resources and Services Administration. http://mchb.hrsa.gov/programs/adolescents/abstinence.htm

14. has as its exclusive purpose, teaching the social, psychological, and health gains to be realized by abstaining from sexual activity; has as its exclusive purpose, teaching the social, psychological, and health gains to be realized by abstaining from sexual activity; teaches abstinence from sexual activity outside marriage as the expected standard for all school age children; teaches abstinence from sexual activity outside marriage as the expected standard for all school age children; teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems; teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems; teaches that a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity; teaches that a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity; teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects; teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects; teaches that bearing children out of wedlock is likely to have harmful consequences for the child, the child’s parents, and society; teaches that bearing children out of wedlock is likely to have harmful consequences for the child, the child’s parents, and society; teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances; and teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances; and teaches the importance of attaining self-sufficiency before engaging in sexual activity. teaches the importance of attaining self-sufficiency before engaging in sexual activity.

15. School districts with a sex education policy universally require that abstinence be taught and around 4 in 5 require that it be promoted as the best option for young people. School districts with a sex education policy universally require that abstinence be taught and around 4 in 5 require that it be promoted as the best option for young people. About 35% not only require abstinence to be covered but either do not allow discussion of contraceptives or allow discussion only of their failure rates. About 35% not only require abstinence to be covered but either do not allow discussion of contraceptives or allow discussion only of their failure rates. The other 51% require that abstinence be taught as the preferred option, but also allow discussion of contraception as an effective means of protection. The other 51% require that abstinence be taught as the preferred option, but also allow discussion of contraception as an effective means of protection. Only 14% have a policy of teaching abstinence as part of comprehensive programme[1]. Only 14% have a policy of teaching abstinence as part of comprehensive programme[1].[1] 46% of parents prefer an abstinence-plus approach,36% a comprehensive approach and 15% abstinence only[2]. 46% of parents prefer an abstinence-plus approach,36% a comprehensive approach and 15% abstinence only[2].[2] In the UK an even greater proportion of parents and young people support comprehensive approaches to sex education[3]. In the UK an even greater proportion of parents and young people support comprehensive approaches to sex education[3].[3] [1][1] Landry, D.J., Kaeser, L. and Richards, C.L. (1999) Abstinence promotion and the provision of information about contraception in public school district sexuality education policies, Family Planning Perspectives, 31(6):280-286. [1] [2][2] National Public Radio/Kaiser Family Foundation/John F Kennedy School of Government Harvard University (2004) Sex Education in America, Kaiser Family Foundation. http://www.kff.org/kaiserpolls/pomr012904oth.cfm [2] [3][3] BMRB International (2001) Evaluation of the Teenage Pregnancy Strategy. Tracking Survey. Report of results of benchmark wave, January 2001. www.teenagepregnancyunit.gov.uk [3]

16. PEPFAR (President’s Emergency Plan For AIDS Relief ) $15 billion to worst affected countries in Africa and Caribbean [1] ; $15 billion to worst affected countries in Africa and Caribbean [1] ; 20% for HIV/AIDS prevention (of which at least 33% is to be spent on abstinence until marriage programs); 20% for HIV/AIDS prevention (of which at least 33% is to be spent on abstinence until marriage programs); Learning from Uganda (ABC) Learning from Uganda (ABC) [1] Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia.