Facts, Attitudes, and Health Reasoning About HIV and AIDS: Explaining the Education Effect on Condom Use Among Adults in Sub-Saharan Africa

Abstract

In contrast to earlier in the HIV/AIDS pandemic, net of other demographic factors, formal education acts as a preventative factor in sub-Saharan Africa. Despite this trend, there has been almost no research on the causal mechanisms behind the widely reported education effect. Consistent with the education effect, structural equation modeling of the influence of education attainment on condom use with Demographic Health Survey data from nine sub-Saharan Africa nations collected between 2003 and 2005 finds that net of control variables, there is a robust, positive influence of education on condom use among sexually risky adults. Information-transfer and attitude change, the two most commonly assumed educational influences on the use of condoms, are tested, and although education attainment increases acquisition of basic facts and the inculcation of positive attitudes about HIV/AIDS, these factors have only weak influence on condom use. Given this, a new hypothesis about education's enhancement of health reasoning is developed from neuro-developmental and decision-making research. Modeling finds that education robustly influences health reasoning ability and this factor mediates a significant proportion of the education effect on condom use. The results raise concern about the enormous effort by NGOs in the region to use mainly fact- and attitude-based educational programs to reduce future HIV infections. Future research on the causal mechanisms behind the association between education and HIV/AIDS prevention should focus how on schooling enhances the cognitive skills needed for health reasoning.

Covariates of condom use in South Africa: findings from a national population-based survey in 2008

“…These findings contradict previous research findings by Chimbindi et al (2010) in rural KwaZulu-Natal in South Africa and in other countries (e.g., Baker, Leon, & Collins, 2011) which show the opposite relationships which were explained by the belief that poverty leads to risk behaviour such as early sexual debut and less frequent use of condoms which puts poor people at risk of HIV infection (APA, n.d.; Davidoff-Gore, Luke, & Wawire, 2011). However, as HIV prevalence is highest among those who are poor and unemployed with low education and predominantly Black African, it is, therefore, not surprising that the poor also tend to use condoms more in order to protect themselves.…”

A meta-analysis of education effects on chronic disease: The causal dynamics of the Population Education Transition Curve

“…5. Past research on schooling effects shows that education affects health through several causal pathways (Baker et al, 2010;Cutler and Lleras-Muney, 2010;Ross and Mirowsky, 1999). Most important among these pathways are material or economic benefits (e.g.…”

“…Fernald and Adlet, 2007). Similarly, while education's enhancement of cognition and empowerment attitudes functions to improve health and postpone onset of chronic disease, these assets can be neutralized without accurate information about a disease and its causes (Smith et al, 2012;Baker et al, 2011Baker et al, , 2010Baker et al, , 2009. Given this, the key to explaining the PET curve lies in understanding how population contexts interact with education's causal pathways, and under which conditions certain factors become dominant or suppressed in guiding comprehension and behavior.…”

Factors Determining Media-based Partner/Spouse Seeking in the Era of HIV and AIDS Pandemic

“…With no treatment or cure in sight, the disease continues to spread. Globally, an estimated 36.9 million people are living with HIV (UNAIDS, 2014) [1,2]. Over 90% of these individuals are concentrated in the developing countries, mostly in countries least able to afford care for infected people.…”