Most studies in Africa have shown that higher education levels are linked to greater risk of HIV infection. Research spanning a decade in rural Masaka District, south-west Uganda, suggests that this is changing, especially among young women.

Although schooling can boost access to and understanding of health promotion campaigns, it also leads to greater wealth and mobility, increasing the potential exposure to HIV infection. To clarify the balance of these effects, researchers at the MRC/UVRI Uganda Research Unit on AIDS in Entebbe looked at changes in schooling levels, HIV prevalence and condom use in Masaka between 1989/1990 and 1999/2000.

They found that:

• In 1989/1990, higher educational attainment was associated with greater risk of HIV infection, especially among men, but actually this could be explained by the age of the groups surveyed.
• In 1999/2000, for females aged 18-29 years, there is a significant link between higher educational level and lower HIV prevalence, even taking into account age, gender, marital status and wealth.
• There is no clear relationship between education and HIV infection in younger or older males.
• Condom use has increased in the surveyed population over time.
• There is a strong association between higher schooling levels and the likelihood of ever having used a condom.
• While the level of condom use is higher among males, the link between education and condom use is stronger for women.

Over the decade there has been an increase in the general level of education and the supply of schools in the area. Higher education levels are increasingly linked with less HIV infection, especially for young people. More educated young adults, especially women, have become more likely to respond to HIV/AIDS information and prevention campaigns by effectively reducing their sexual risk behaviour. One potential explanation is that education promotes confidence in decision-making and will particularly help women, who typically play a subservient role in sexual negotiation.

This is an age group in which individuals will have started their sexual life after the beginning of HIV/AIDS information campaigns. The study suggests that, once information about HIV and its prevention is spread, more educated young individuals are able to adapt more quickly and change their behaviour. From a policy perspective, this study is encouraging. The researchers conclude that:

• Information campaigns can be effective in changing behaviour.
• The role of the education sector in fighting the epidemic should not be overlooked, especially in many African countries where it is itself under great strain due to the disease.
• In the long run, a more educated population is more responsive to health promotion campaigns.
• Alternative approaches are needed to reach less educated individuals.

Source(s):
‘Changing association between schooling levels and HIV-1 infection over 11 years in a rural population cohort in south-west Uganda’, Tropical Medicine and International Health 10 (10): 993-1001, by D. de Walque, J. Nakiying-Miiro, J. Busingye and J. Whitworth, 2005

Funded by: UK Medical Research Council and the UK Department for International Development

id21 Research Highlight: 6 January 2006

Further Information:
Damien de Walque
Development Research Group
The World Bank
1818 H Street, NW
Washington
DC 20433
USA

Tel: +1 202 473 2517
Fax: +1 202 522 1154
Contact the contributor: ddewalque@worldbank.org

The World Bank

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'Clearing up confusion: peer-led AIDS education in Zambia'

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