Effect of Schooling on Age-Disparate Relationships and Number of Sexual Partners Among Young Women in Rural South Africa Enrolled in HPTN 068

Abstract

Background Attending school may have a strong preventative association with sexually transmitted infections among young women, but the mechanism for this relationship is unknown. One hypothesis is that students who attend school practice safer sex with fewer partners, establishing safer sexual networks that make them less exposed to infection. Setting We used longitudinal data from a randomized controlled trial of young women age 13-20 in the Bushbuckridge district, South Africa, to determine if the percentage of school days attended, school dropout and grade repetition are associated with having a partner five or more years older (age-disparate) and with the number of sexual partners in the previous 12 months. Methods Risks of having an age-disparate relationship and counts of sex partners were compared using inverse probability of exposure weighted Poisson regression models. Generalized estimating equations were used to account for repeated measures. Results Young women who attended fewer school days (<80%) and who dropped out of school were more likely to have an age-disparate relationship (risk difference (RD) 9.9%, 95% CI 3.9%,16.0%; RD (%) dropout 17.2%, 95% CI: 5.4%,29.0%) and those who dropped out reported having fewer partners (count difference (CD) dropout 0.343, 95% CI: 0.192, 0.495). Grade repetition was not associated with either behavior. Conclusion Young women who less frequently attend school or who drop out are more likely to have an age-disparate relationship. Young women who drop out have more partners overall. These behaviors may increase risk of exposure to HIV infection in young women out of school.

Village community mobilization is associated with reducedHIVincidence in young South African women participating in theHPTN068 study cohort

“…Indeed, adolescent involvement in sports, clubs, and other organizations (either in school or extracurricular groups) can provide young people with a sense of meaning or belonging and has been associated with better health outcomes, including improved sexual health . Youth engagement in activities would also bring increased social contact with other youth, and therefore could also imply more protective sexual networks with less time to venture outside of those safer networks (for example with older partners who are more likely to be infected) . It is also possible that this domain is synergistic with leadership, in that communities with more accountable and inclusive leadership may also have more opportunities for organizations and networks to thrive, both of which contribute to (and are fortified by) having a more engaged citizenry.…”

The effect of school attendance and school dropout on incident HIV and HSV-2 among young women in rural South Africa enrolled in HPTN 068

“…Associations with frequency of school attendance in young women indicate that spending more time in school may impose time and sexual network constraints that reduce exposure to infection, and that these reductions may or may not be related to school performance. More research is needed to better understand the mechanism by which education reduces risk of HIV and HSV-2, but other analyses from our study in South Africa indicate that school attendance affects partner selection including both partner age difference and number of sexual partners [20]. …”

“…Almost all villages in the study area have a high school. The most common reason for school drop out is being pregnant or having a child and the most common reason for low attendance is being sick or disabled followed by having to help at home [20]. …”

MicroCOSM: a model of social and structural drivers of HIV and interventions to reduce HIV incidence in high-risk populations in South Africa

“…Another study that used the same dataset found that school enrolment in 2002 was associated with a reduced rate of later sexual debut, although this was only statistically significant in boys [168]. A recent study in Mpumalanga province found that girls who had dropped out of school had 1.85 times as many sexual partners as girls of the same age who did not drop out of school, although this study did not specifically assess sexual debut or control for possible confounding due to pregnancy-related dropout [169]. The evidence therefore suggests that being in school reduces the chance of starting sexual activity, but it is less clear whether educational attainment affects sexual debut, after controlling for age and current school enrolment.…”

“…The evidence therefore suggests that being in school reduces the chance of starting sexual activity, but it is less clear whether educational attainment affects sexual debut, after controlling for age and current school enrolment. Some evidence suggests that youth who are enrolled in school but with relatively low grade advancement have lower rates of sexual debut [88], while other evidence suggests the opposite [82], and some studies suggest no significant effect of grade repetition on sexual behaviour [166, 169].…”