A wasted billion dollars

The United States government has spent $1.3 billion since 2005 encouraging Africans to avoid AIDS by practicing abstinence and fidelity did not measurably change sexual behavior and was largely wasted, according toa study.

The researcher, Nathan Lo, analyzed records showing the age of people having sex for the first time, teenage pregnancy and number of sexual partners in international health surveys that have been paid for by the State Department since the 1970s. Mr. Lo said he spent a year analyzing dozens of health surveys that the United States paid for in countries around the world. Originally called the World Fertility Surveys, they were begun in the 1970s. They were later subsumed into the large Demographic and Health Surveys, now paid for by the United States Agency for International Development, that document health behaviors in dozens of countries. Lo compared data from 1998 to the present in 22 African countries, 14 of which received Pepfar money and eight that did not. He looked at answers to three questions that are part of the extensive questionnaire given to people interviewed: What was your age when you had sex for the first time? At what age did you have your first child? How many people have you had sex with in the last year? When answers about age at loss of virginity did not appear to be truthful, he said, he used a conservative form of adjustment, calculating backward from the birth of the first child.

President George W. Bush’s global AIDS plan was enacted in 2003 and marshaled billions of dollars to treat Africans who had AIDS with lifesaving drugs. Conservative Republican leaders in the House of Representatives successfully included a provision that one-third of AIDS prevention money go to programs to encourage abstinence and fidelity. That campaign — known as ABC, for abstain, be faithful and use condoms — was part of the bargain made when Christian conservatives joined with liberals to pass the law. Spending on abstinence and fidelity peaked in 2005 and began to drop after the Obama administration took office.

The differences between the Pepfar  (President’s Emergency Plan for AIDS Relief) and non-Pepfar countries did not change after 2005. That indicated “no detectable effect” from the expenditure, he said. The differences were so small that, for example, men in the Pepfar countries appeared to have 0.02 more sexual partners after the abstinence and fidelity funding began than they had before.