Underhill K, Montgomery P, Operario D
Cochrane Database Syst Rev. 2008 Jan 23(1):CD007006. doi: 10.1002/14651858.CD007006.
Abstinence-plus interventions promote sexual abstinence as the best means of preventing acquisition of HIV, but also encourage safer-sex strategies (eg condom use) for sexually active participants.
To assess the effects of abstinence-plus programs for HIV prevention in high-income countries.
We searched 30 electronic databases (eg CENTRAL, PubMed, EMBASE, AIDSLINE, PsycINFO) ending February 2007. Cross-referencing, hand-searching, and contacting experts yielded additional citations.
We included randomized and quasi-randomized controlled trials evaluating abstinence-plus interventions in high-income countries (as defined by the World Bank). Interventions were any efforts that encouraged sexual abstinence as the best means of HIV prevention, but also promoted safer sex. Results were self-reported biological outcomes, behavioral outcomes, and HIV knowledge.
Three reviewers independently appraised 20070 citations and 325 full-text papers for inclusion and methodological quality; 39 evaluations were included. Due to heterogeneity and data unavailability, we presented the results of individual studies instead of a meta-analysis.
Studies enrolled 37724 North American youth; participants were ethnically diverse. Programs took place in schools (10), community facilities (24), both schools and community facilities (2), healthcare facilities (2), and family homes (1). Median final follow-up occurred 12 months after baseline. Results showed no evidence that abstinence-plus programs can affect self-reported sexually transmitted infection (STI) incidence, and limited evidence that programs can reduce self-reported pregnancy incidence. Results for behavioral outcomes were promising; 23 of 39 evaluations found a significantly protective intervention effect for at least one behavioral outcome. Consistently favorable program effects were found for HIV knowledge.No adverse effects were observed. Several evaluations found that one version of an abstinence-plus program was more effective than another, suggesting that more research into intervention mechanisms is warranted. Methodological strengths included large samples and statistical controls for baseline values. Weaknesses included under-utilization of relevant outcomes, self-report bias, and analyses neglecting attrition and clustered randomization.
AUTHORS' CONCLUSIONS: Many abstinence-plus programs appear to reduce short-term and long-term HIV risk behavior among youth in high-income countries. Evidence for program effects on biological measures is limited. Evaluations consistently show no adverse program effects for any outcomes, including the incidence and frequency of sexual activity. Trials comparing abstinence-only, abstinence-plus, and safer-sex interventions are needed.
禁欲加干预措施将性禁欲作为预防感染艾滋病毒的最佳手段加以推广，但同时也鼓励性活跃参与者采取更安全的性行为策略（如使用避孕套）。
评估在高收入国家开展的禁欲加项目对预防艾滋病毒的效果。
我们检索了截至2007年2月的30个电子数据库（如Cochrane系统评价数据库、PubMed、EMBASE、艾滋病在线数据库、心理学文摘数据库）。通过交叉引用、手工检索及与专家联系获取了更多的文献。
我们纳入了评估在高收入国家（按世界银行定义）开展的禁欲加干预措施的随机对照试验和半随机对照试验。干预措施是指任何鼓励将性禁欲作为预防艾滋病毒的最佳手段，但同时也推广更安全性行为的努力。结果包括自我报告的生物学指标、行为学指标及艾滋病毒知识。
三名评价员独立评估了20070条文献和325篇全文论文，以确定是否纳入及方法学质量；纳入了39项评估。由于存在异质性且数据不可用，我们呈现的是各个研究的结果而非Meta分析结果。
研究纳入了37724名北美青少年；参与者种族多样。项目在学校开展的有10项，在社区机构开展的有24项，在学校和社区机构均开展的有2项，在医疗机构开展的有2项，在家庭开展的有1项。末次随访的中位数时间为基线后12个月。结果显示，没有证据表明禁欲加项目能影响自我报告的性传播感染（STI）发病率，仅有有限的证据表明该项目能降低自我报告的妊娠发病率。行为学指标的结果令人鼓舞；39项评估中有23项发现该干预措施对至少一项行为学指标有显著的保护作用。在艾滋病毒知识方面始终发现该项目有积极效果。未观察到不良影响。几项评估发现一种版本的禁欲加项目比另一种更有效，这表明有必要对干预机制开展更多研究。方法学优势包括样本量大及对基线值进行了统计学对照。劣势包括未充分利用相关指标、自我报告偏倚以及分析时忽略了失访和整群随机化。
许多禁欲加项目似乎能降低高收入国家青少年短期和长期的艾滋病毒风险行为。该项目对生物学指标影响的证据有限。评估始终表明该项目对任何指标均无不良影响，包括性活动的发生率和频率。需要开展比较单纯禁欲、禁欲加及更安全性行为干预措施的试验。
