Transitions: The Controversy over Abstinence-Only-Until-Marriage Programs
Volume 12, No. 3, March 2001

This Transitions is also available in [PDF] format.

A new report by the Institute of Medicine's Committee on HIV Prevention Strategies in the United States reminds Americans that half of all new HIV infections occurs in youth under age 25. One-fourth of all new HIV infections occurs in youth under age 21. Asserting that the United States has no time to lose if it is to reverse the distressing trend toward infection in ever-younger people, the Committee flatly asserts that the nation needs leaders who will work to overcome social barriers and to capitalize on unrealized opportunities to prevent HIV. The Committee believes that the nation should have an explicit HIV prevention goal: to avert as many new HIV infections as possible with the resources available for HIV prevention.

Moreover, the Committee recognized that many factors can undermine public health goals:

• Using inappropriate considerations to frame policy choices
• Applying less than desirable rules to public health problems
• Allowing prejudice and individual/sectarian values to undermine policy goals
• Allocating insufficient resources
• Allowing organizational factors to impede policy implementation
• Permitting inadequate training or other failures in implementation to undermine successful outcomes.

Therefore, the Committee recommended six important elements to allow the nation to meet the HIV prevention goal of averting as many new HIV infections as possible.

1. Develop an accurate surveillance system focused on new HIV infections.
2. Allocate resources to prevent as many new HIV infections as possible.
3. Use the clinical setting for prevention activities, including testing, counseling, and treatment for HIV infected individuals.
4. Translate research into action.
5. Invest in the development of new tools and technologies for HIV prevention.
6. Strive to overcome social barriers.

Under social barriers needing dismantling, the Committee particularly noted barriers to effective sexuality education. The Committee specifically recommended eliminating congressional, federal, state, and local requirements that public funds be used for abstinence-only education and that states and local school districts implement and continue to support age-appropriate comprehensive sex education and condom availability programs.

Committee on HIV Prevention Strategies in the United States, Institute of Medicine. No Time to Lose: Getting More from HIV Prevention. Washington, DC: National Academy Press, in press.