Definition of the Prevention Area
Delay of sexual debut is an important tactic in HIV prevention among youth, resulting in fewer years at high risk. "Abstinence-only" programs, which promote complete sexual abstinence as the only effective method for preventing unintended pregnancy and sexually transmitted infections including HIV, have not been demonstrated to reduce HIV risk behaviors. Recommended instead are comprehensive sexual education programs that include sex education and information on abstinence, delay of sexual debut, partner limitation, condom use, and contraception.
Epidemiological Justification for the Prevention Area
Several national demographic surveys have found a correlation between early onset of sexual activity and higher HIV prevalence among young people, who may not be biologically or psychologically ready for sex. In fact, older age at first sex appears to be one contributing factor in declines in HIV prevalence among youth in sub-Saharan countries with generalized epidemics.
Core Programmatic Components
Efforts to delay sexual debut should be incorporated into comprehensive sexual education programs and should begin early, offering age-appropriate messages over time. Comprehensive sexual education programs are typically targeted towards youth and are predominately school-based. Opportunities to reach out-of-school youth, who may be at heightened vulnerability, should be identified as well. Comprehensive programs may include messages that:
- Reinforce positive individual and group norms
- Teach safer sex practices for young people who are already sexually active
- Offer opportunities to practice skills in negotiating for safer sex or refusing sex
- Provide access to condoms.
Several studies show that such programs can help to achieve desired behavior changes without leading to an increase in participants' sexual activity.
Current Status of Implementation Experience
According to a report by the U.S. Institute of Medicine (IOM), effective programs were comprehensive, combining abstinence messages with safer sex education and condom availability. A media campaign in Zambia that conveyed age-appropriate messages to youth suggests that media campaigns can be useful adjuncts to programs encouraging delayed sexual debut as part of a comprehensive sexual education program.