Abstinence and Teens: Prevention counseling practices of health care providers in the United States

Recent research shows little impact of abstinence education on teen sexual risk behaviors, despite significant policy and funding efforts. The concept of abstinence is polarized and politicized, and the struggle over resources and programs to support teens is highly visible in the policy arena. However, little data exists on how abstinence is viewed by providers serving teen patients, and whether they have integrated the concept into their prevention counseling services. We conducted in-depth interviews with physicians and nurse practitioners (n=31) in 6 regions of the U.S. with elevated rates of heterosexually transmitted HIV. The semi-structured interview guide included items on prevention counseling for pregnancy and HIV/STIs. Thematic content analysis showed that providers included abstinence as one of the choices presented to teens, along with contraception and condoms, and refer to this approach as “abstinence plus.” Several providers mentioned that with young teens, they assessed whether they felt ready to be sexually active and tried to impart skills to have the relationships that they wanted to have. Some saw abstinence as giving teens a way to opt out of unwanted sexual activity. Providers discussed delaying sexual activity and other ways to be affectionate, while dispensing contraception to the same patients. Many used a patient-centered approach in which they supported abstinence if that was the patient's desire, but routinely dispensed condoms. Overall, providers did not use abstinence as a dichotomized, rigid concept in their prevention practices, but as a health tool to give agency to teens within a harm reduction approach.