Abstracts of Cochrane Reviews

The editors of the International Journal of Gynecology & Obstetrics have selected the following abstracts of articles published in The Cochrane Library, because of their particular interest to parcticing specialists in obstetrics and gynecology in all areas of the world. The full text of the review is available in The Cochrane Library (ISSN 1464–780X). From the Cochrane Database of Systematic Reviews 2008 Issue 2. Copyright © 2008. The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.

Abstinence-plus programs for preventing HIV infection in high-income countries (as defined by the World Bank).

Underhill K, Montgomery P, Operario O. Abstinence-plus programs for preventing HIV infection in high-income countries (as defined by the World Bank). Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD007006. DOI: 10.1002/14651858.CD007006.

Summary

Abstinence-plus programs for preventing HIV infection in high-income countries (as defined by the World Bank).

Abstinence-plus programs are widespread interventions that primarily target young people. On the premise that sexual abstinence is the best way to prevent HIV, abstinence-plus interventions aim to prevent, stop, or decrease sexual activity; however, programs also promote condom use and other safer-sex strategies as alternatives for sexually active participants. Abstinence-plus programs differ from abstinence-only interventions, which promote abstinence as the exclusive means of HIV prevention without encouraging safer sex.

This review included 39 randomized and quasi-randomized controlled trials comparing abstinence-plus programs to various control groups (e.g. “usual care,” no intervention). Although we conducted an extensive international search for trials, all included studies were conducted among youth in the US, Canada, and the Bahamas (total baseline enrolment=37724 participants). The included programs took place in schools, community centers, and healthcare facilities. We did not conduct a meta-analysis because of missing data and variation in program designs.

Using various control groups, 24 of 39 evaluations showed a significantly protective intervention effect on at least one biological or behavioral outcome at short-term, medium-term, or long-term follow-up. Eight trials found no evidence that abstinence-plus programs affect self-reported sexually transmitted infection (STI) incidence and limited evidence that programs have a protective effect on self-reported pregnancy incidence. Results for behavioral outcomes were inconsistent across studies. Findings in almost every trial assessing HIV-related knowledge favored the intervention group over controls. No harms were observed for any outcome, including incidence and frequency of sexual activity.

Limitations for this review include underreporting of relevant outcomes, reliance on program participants to report their behaviors accurately, and methodological weaknesses in the trials.

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