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No Time to Lose: Getting More from HIV Prevention
(AFLA) and the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) (42 U.S.C.A. §§ 601 et seq.). The AFLA, which provides funds for abstinence-only sex education under Title XX of the Public Health Service Act, was enacted by Congress with the primary goal of preventing teenage pregnancy by promoting abstinence education, providing care for pregnant and parenting teens, and conducting research on teen sexuality. Since 1982, an estimated $60 million has been spent on some form of abstinence education through AFLA, although no exact figures are available (Kaiser Family Foundation, 1999c). The PRWORA, which was part of the 1996 welfare reform law, provides states with a total of $50 million annually for five years, from FY1998 through FY2002, to support abstinence-unless-married education programs.15 States that accept federal funding are required to provide 75 percent in matching funds, resulting in a total of as much as $87.5 million per year ($437.5 million over five years) for abstinence-only programs. By FY99, all 50 states, Puerto Rico, and the Virgin Islands had applied for and received funding under PRWORA for abstinence-only education. Recent reviews show that states use their funds for a wide array of programs, including school- and community-based programs (SIECUS, 1999). A national evaluation of this initiative is currently being conducted using funds allocated as a part of the Balanced Budget Act of 1997, and many states are undertaking separate evaluations of their programs (AMCHP, 1999).
The Committee believes that investing hundreds of millions of dollars of federal and state funds over five years in abstinence-only programs with no evidence of effectiveness constitutes poor fiscal and public health policy. The Committee concurs with the prior conclusion of the National Institutes of Health Consensus Panel on Interventions to Prevent HIV Risk Behaviors (NIH, 1997b): that legislative restrictions discouraging ef-
The law defines an abstinence education program as having eight components that teach:
• abstinence has social, psychological, and health benefits;
• unmarried, school-aged children are expected to abstain from sex;
• abstinence is the only certain way to prevent out-of-wedlock pregnancy and STDs;
• a mutually faithful monogamous married relationship is the standard for sexual activity;
• sexual activity outside marriage is likely to have harmful psychological and physical effects;
• out-of-wedlock childbearing is likely to harm the child, the parents, and society;
• how to reject sexual advances and how alcohol and drug use increases vulnerability to them; and
• the importance of attaining self-sufficiency before engaging in sex.