Did PEPFAR Impact the ABCs of HIV Prevention?

Background: The President’s Emergency Plan for AIDS Relief (PEPFAR) is former President Bush’s signature global health initiative, which channeled billions of dollars into the global HIV/AIDS epidemic in 15 focal countries since 2004. Thirty percent of this global funding went towards PEPFAR’s controversial prevention policies, including its ABC approach (Abstain, Be faithful, Condomize).  This investigation was undertaken to assess the impact of PEPFAR funding on sexual behavior relating to the ABCs of prevention in PEPFAR focal countries compared with similar countries that did not receive PEPFAR funding. Methods: Country-level data on five variables among youth—abstinence, multiple partners, condom use, and sex before the ages of 15 and 18—were collected from nationally-representative Demographic and Health Surveys. Nine PEPFAR-focus countries and five non-PEPFAR-focus countries in sub-Saharan Africa with data supporting pre-PEPFAR (1999-2003) and PEPFAR (2004-2011) years were selected for evaluation.    Results: Paired samples t-tests and Wilcoxon non-parametric tests were conducted to assess differences in the change in mean prevalence rates of behavioral variables between PEPFAR and non-PEPFAR countries in the pre-PEPFAR and PEPFAR periods.  The results showed that the means of the variables from PEPFAR-focus countries were not significantly different from controlson any of the four variables assessed including pre-marital abstinence (p-values ranging from 0.51 to 0.92).  Conclusion: These results suggest that PEPFAR behavioral prevention funding has not had a substantial impact on sexual behavior in spite of the billions of dollars invested in these programs.