Have the educated changed HIV risk behaviours more in Africa?

Gummerson, Elizabeth

doi:10.2989/16085906.2013.863216

Cited by 7 publications

(5 citation statements)

References 27 publications

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“…However, this finding is consistent with previous studies identifying more sluggish uptake of health interventions among less-educated populations [ 27 , 45 – 47 ]. Because less educated individuals are at higher risk of contracting HIV both in South Africa and elsewhere in sub-Saharan Africa [ 26 , 27 , 48 – 50 ], it is imperative for HCT services to reach this population. The failure of the campaign to proportionally increase testing among the less educated may, in part, have been influenced by the mass media advertising employed during the campaign, to which the educated likely had greater exposure [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

Changes in self‐reported HIV testing during South Africa's 2010/2011 national testing campaign: gains and shortfalls

Maughan-Brown

Lloyd

Bor

et al. 2016

Journal of the International AIDS Society

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ObjectivesHIV counselling and testing is critical to HIV prevention and treatment efforts. Mass campaigns may be an effective strategy to increase HIV testing in countries with generalized HIV epidemics. We assessed the self-reported uptake of HIV testing among individuals who had never previously tested for HIV, particularly those in high-risk populations, during the period of a national, multisector testing campaign in South Africa (April 2010 and June 2011).DesignThis study was a prospective cohort study.MethodsWe analyzed data from two waves (2010/2011, n=16,893; 2012, n=18,707) of the National Income Dynamics Study, a nationally representative cohort that enabled prospective identification of first-time testers. We quantified the number of adults (15 years and older) testing for the first time nationally. To assess whether the campaign reached previously underserved populations, we examined changes in HIV testing coverage by age, gender, race and province sub-groups. We also estimated multivariable logistic regression models to identify socio-economic and demographic predictors of first-time testing.ResultsOverall, the proportion of adults ever tested for HIV increased from 43.7% (95% confidence interval (CI): 41.48, 45.96) to 65.2% (95% CI: 63.28, 67.10) over the study period, with approximately 7.6 million (95% CI: 6,387,910; 8,782,986) first-time testers. Among black South Africans, the country's highest HIV prevalence sub-group, HIV testing coverage improved among poorer and healthier individuals, thus reducing gradients in testing by wealth and health. In contrast, HIV testing coverage remained lower for men, younger individuals and the less educated, indicating persistent if not widening disparities by gender, age and education. Large geographic disparities in coverage also remained as of 2012.ConclusionsMass provision of HIV testing services can be effective in increasing population coverage of HIV testing. The geographic and socio-economic disparities in programme impacts can help guide best practices for future efforts. These efforts should focus on hard-to-reach populations, including men and less-educated individuals.

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Section: Discussionmentioning

confidence: 99%

Changes in self‐reported HIV testing during South Africa's 2010/2011 national testing campaign: gains and shortfalls

Maughan-Brown

Lloyd

Bor

et al. 2016

Journal of the International AIDS Society

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“…A more recent and growing body of work has demonstrated causal associations between greater educational attainment and lower HIV risk in several sub-Saharan African countries (Alsan & Cutler, 2013; Behrman, 2015; De Neve, Fink, Subramanian, Moyo, & Bor, 2015; Dupas, 2011). The underlying mechanisms may include increased exposure to HIV prevention messages and uptake of related HIV prevention activities, such as condom use, abstinence, and male circumcision (Agüero & Bharadwaj, 2014; Gummerson, 2013; Gummerson, Maughan-Brown, & Venkataramani, 2013). …”

Section: Introductionmentioning

confidence: 99%

The causal effect of education on HIV stigma in Uganda: Evidence from a natural experiment

Tsai

Venkataramani

2015

Social Science & Medicine

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Rationale HIV is highly stigmatized in sub-Saharan Africa. This is an important public health problem because HIV stigma has many adverse effects that threaten to undermine efforts to control the HIV epidemic. Objective The implementation of a universal primary education policy in Uganda in 1997 provided us with a natural experiment to test the hypothesis that education is causally related to HIV stigma. Methods For this analysis, we pooled publicly available, population-based data from the 2011 Uganda Demographic and Health Survey and the 2011 Uganda AIDS Indicator Survey. The primary outcomes of interest were negative attitudes toward persons with HIV, elicited using four questions about anticipated stigma and social distance. Results Standard least squares estimates suggested a statistically significant, negative association between years of schooling and HIV stigma (each P<0.001, with t-statistics ranging from 4.9 to 14.7). We then used a natural experiment design, exploiting differences in birth cohort exposure to universal primary education as an instrumental variable. Participants who were <13 years old at the time of the policy change had 1.36 additional years of schooling compared to those who were ≥13 years old. Adjusting for linear age trends before and after the discontinuity, two-stage least squares estimates suggested no statistically significant causal effect of education on HIV stigma (P-values ranged from 0.21 to 0.69). Three of the four estimated regression coefficients were positive, and in all cases the lower confidence limits convincingly excluded the possibility of large negative effect sizes. These instrumental variables estimates have a causal interpretation and were not overturned by several robustness checks. Conclusion We conclude that, for young adults in Uganda, additional years of education in the formal schooling system driven by a universal primary school intervention have not had a causal effect on reducing negative attitudes toward persons with HIV.

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“…Namely, that education improves how individuals process availability of information about gaining control of their health, whether through improved understanding of promotional materials, changes in their self-efficacy and sense of agency, or through more effective interactions with health care providers. Studies have found that educated individuals tend to adopt more protective behaviours such as condom use, testing for HIV (1)(2)(3), and abstaining from sex (4). Using an instrumental variable approach Agüero and Bharadwa (5) found that secondary education reduces the number sexual partners in Zimbabwe and increases comprehensive knowledge about HIV, echoing the results of de Walque in five African countries (1).…”

Section: Introductionmentioning

confidence: 94%

“…However, some studies have found an opposite pattern, namely a positive association between education and HIV prevalence in sub-Saharan Africa (SSA) (9,10). These studies showed that more educated individuals are more likely than the non-educated to adopt risky sexual behaviours such as having more sexual partners (3,11,12), premarital sex (9) or lower abstinence and higher level of infidelity (1).…”

Section: Introductionmentioning

confidence: 99%

The Impact of the Quality of Sexual Education on HIV/AIDS in Zambia: Evidence from a Natural Experiment

Fotso

Findley

Chisumpa³

et al. 2020

Preprint

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Background:This paper focuses on how sexual education quality is associated with HIV-related knowledge, stigma and risky sexual behaviour among Zambians. The implementation of the Comprehensive Sexuality Education programme since 2014, with sequential in-service teacher training provides a natural experiment for testing the hypothesis that quality of sexual education, not quantity only, is positively associated with HIV knowledge, and negatively associated with risky sexual behaviours and stigma. Methods:Data are drawn from the 2016 Zambian Population-Based HIV Impact Assessment survey, which sampled 24,663 individuals aged 15-59 years old nationwide. Province fixed-effects double difference model is used to test our hypothesis. Results:We found that sexual education with well-trained teachers reduced the number of HIV-related stigma by 0.13 points, while as expected it was associated with a greater number of correct HIV-related knowledge (0.29 points). No significant association was found between quality of sex education and risky sexual behaviours. Conclusion:These results point to the importance of investing in high quality sexual education to combat the HIV-AIDS progression.

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Have the educated changed HIV risk behaviours more in Africa?

Cited by 7 publications

References 27 publications

Changes in self‐reported HIV testing during South Africa's 2010/2011 national testing campaign: gains and shortfalls

Changes in self‐reported HIV testing during South Africa's 2010/2011 national testing campaign: gains and shortfalls

The causal effect of education on HIV stigma in Uganda: Evidence from a natural experiment

The Impact of the Quality of Sexual Education on HIV/AIDS in Zambia: Evidence from a Natural Experiment

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