Sexual behaviour and the ability to change that behaviour are likely to be linked to education level. But does schooling increase or decrease the risk of HIV infection? Research by the Study Group on Heterogeneity of HIV Epidemics in African Cities looks at the link between education and behaviour in Cotonou (Benin), Yaoundé (Cameroon), Kisumu (Kenya) and Ndola (Zambia).

In the early years of the HIV epidemic, infection was more common in better-educated people, but it was predicted that this pattern would change. Higher socio-economic status, travel opportunities and delayed marriage are related to greater education and can increase the risk of HIV infection. But low education and poverty may increase the exchange of sex for money. So what is the relationship between education and HIV now?

Researchers collected data on education, HIV status and socio-economic and behavioural factors from about 1000 men and 1000 women in each city. They also tested for genital herpes infection as a marker of high-risk sexual behaviour. Overall, they found either no association between schooling and HIV or herpes infection, or that those with more schooling have lower risks of infection. Analysis of the data showed that:

• The overall HIV prevalence is higher in Kisumu and Ndola than in Cotonou and Yaoundé, and higher in women than in men.
• There is no association between schooling and HIV infection in Kisumu or Ndola. In Yaoundé, women with more schooling are less likely to be HIV positive, as are men with more schooling in Cotonou.
• Genital herpes shows different patterns. Among women in Kisumu and Ndola, the risk of herpes infection decreases as the level of schooling increases.
• Among men, genital herpes is less common among those who are more educated in Cotonou and there are similar trends in Ndola and Yaoundé.

The behavioural factors studied do not seem to explain these results. In general, those with more schooling report less risky behaviour, particularly during the last year. Other unmeasured factors which might explain the trends include:

• HIV prevalence among partners of men and women of different socio-economic status
• influence of education on reporting of behaviour
• content of the education received
• expectations and behaviours associated with education and social status.

Although there was some evidence that better education leads to less sexual risk-taking, risky behaviour and sexually-transmitted infections were common at all educational levels. The challenge is to ensure that effective health education reaches everyone. This means improving general education levels, as well as targeting health messages more effectively at those with poor education and empowering them to act on them.

Source(s):
‘Does increased general schooling protect against HIV infection? A study in four African cities’, Tropical Medicine and International Health 9 (1): 4-14, by J. Glynn, et al., 2004

Funded by: UNAIDS; European Commission; Agence National de Recherches sur le SIDA, France; UK Department for International Development; The Rockefeller Foundation; SIDACTION; Fonds voor Wetenschappelijk Onderzoek, Belgium; Glaxo Wellcome; Belgium Development Cooperation

id21 Research Highlight: 16 October 2004

Further Information:
Judith Glynn
Infectious Disease Epidemiology Unit
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Tel: +44 (0)20 7927 2423
Fax: +44 (0)20 7636 8739
Contact the contributor: judith.glynn@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

Other related links:
'Changing behaviour, changing disease – the case of HIV in rural Uganda'

'Transmitting through time: monitoring HIV transmission rates in rural Tanzania'

'On best behaviour: men's attitudes to sexual health in Cambodia'

'Is HIV infection really a curse of the poor? – The case of a Kenyan city'

See id21's collection of links relevant to HIV/AIDS.

'Education attainment as a predictor of HIV risk in rural Uganda: results from a population-based study.' INDEPTH

'Educational attainment and HIV-1 infection in developing countries: a systematic review' - London School of Hygiene and Tropical Medicine