Does increased general schooling protect against HIV infection? A study in four African cities

Authors

  • Judith R. Glynn,

    1.  Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK
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  • Michel Caraël,

    1.  UNAIDS, Geneva, Switzerland
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  • Anne Buvé,

    1.  Institute of Tropical Medicine, Antwerp, Belgium
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  • Séverin Anagonou,

    1.  Programme de Lutte contre le SIDA, Cotonou, Benin
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  • Léopold Zekeng,

    1.  Ministry of Public Health, Yaoundé, Cameroon
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  • Maina Kahindo,

    1.  National AIDS/STD Control Programme, Nairobi, Kenya
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  • Rosemary Musonda,

    1.  Tropical Diseases Research Centre, Ndola, Zambia
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  • for the Study Group on Heterogeneity of HIV Epidemics in African Cities

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    • *

       Members of the Study Group on Heterogeneity of HIV Epidemics in African Cities: A. Buvé (co-ordinator), M. Laga, E. Van Dijck, W. Janssens, L. Heyndricks (Institute of Tropical Medicine, Belgium); S. Anagonou (Programme National de Lutte contre le SIDA, Benin); M. Laourou (Institut National de Statistiques et d'Analyses Economiques, Benin); L. Kanhonou (Centre de Recherche en Reproduction Humaine et en Démographie, Benin); E. Akam, M. de Loenzien (Institut de Formation et de Recherche Démographiques, Cameroon); S.-C. Abega (Université Catholique d'Afrique Centrale, Cameroon); L. Zekeng (Programme de Lutte contre le Sida, Cameroon); J. Chege (The Population Council, Kenya), V. Kimani, J. Olenja (University of Nairobi, Kenya); M. Kahindo (National AIDS/STD control programme, Kenya); F. Kaona, R. Musonda, T. Sukwa (Tropical Diseases Research Centre, Zambia); N. Rutenberg (The Population Council, USA); B. Auvert, E. Lagarde (INSERM U88, France); B. Ferry, N. Lydié (Centre français sur la Population et le Développement, France); R. Hayes, L. Morison, H. Weiss, J.R. Glynn (London School of Hygiene & Tropical Medicine, UK); N.J. Robinson (Glaxo Wellcome R & D, UK, formerly INSERM U88); M. Caraël (UNAIDS, Switzerland).


Authors
Judith Glynn, Infectious Disease Epidemiology Unit, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK. Tel.: +44 20 7927 2423; Fax: +44 20 7636 8739; E-mail: judith.glynn@lshtm.ac.uk (corresponding author).
Michel Caraël, UNAIDS, Av Appia 1211, Geneva 27, Switzerland. E-mail caraelm@unaids.org
Anne Buvé, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium. E-mail: abuve@itg.be
Séverin Anagonou, Programme de Lutte contre le SIDA, BP 04 378 Cotonou, Benin.
Léopold Zekeng, Ministry of Public Health, BP 8166 Yaoundé, Cameroon. E-mail: Leopold.zekeng@camnet.com
Maina Kahindo, National AIDS/STD control programme, PO Box 20781 Nairobi, Kenya. E-mail: mkahindo@fhi.or.ke
Rosemary Musonda, Tropical Diseases Research Centre, PO Box 71769 Ndola, Zambia. E-mail: tdrc@zmanet.zm

Summary

Background  The association between educational attainment and risk of HIV infection varies between populations and over time. Earlier studies in sub-Saharan Africa have found that those with more education are at increased risk of HIV infection.

Methods  We investigated the associations between general schooling and both HIV and herpes simplex-2 (HSV-2) infection using data from the multicentre study on factors determining the differential spread of HIV in four African cities. Cross-sectional general population studies were conducted in 1997–1998 in Cotonou (Benin), Yaoundé (Cameroon), Kisumu (Kenya), and Ndola (Zambia), including about 2000 adults in each city.

Results  There was no association between schooling and HIV infection in men or women in Kisumu or Ndola. Women in Yaoundé and men in Cotonou, with more schooling, were less likely to be HIV positive. These associations persisted after adjusting for sociodemographic factors. Similar trends in men in Yaoundé and women in Cotonou were not statistically significant. Increased schooling was associated with significantly decreased risk of HSV-2 infection in women in Kisumu and Ndola and men in Cotonou. In all the cities those with more education tended to report less risky sexual behaviour.

Conclusions  There was no evidence of an increased risk of HIV infection associated with education as seen in earlier studies. In each city there was some evidence of lower HIV or HSV-2 infection rates and less risky sexual behaviour associated with increased education levels. The most educated may be responding more readily to health education programmes. The challenge is to extend this to the rest of the population.

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