OBJECTIVE: To assess the evidence that the association between educational attainment and risk of HIV infection is changing over time in sub-Saharan Africa. DESIGN AND METHODS: Systematic review of published peer-reviewed articles. Articles were identified that reported original data comparing individually measured educational attainment and HIV status among at least 300 individuals representative of the general population of countries or regions of sub-Saharan Africa. Statistical analyses were required to adjust for potential confounders but not over-adjust for variables on the causal pathway. RESULTS: Approximately 4000 abstracts and 1200 full papers were reviewed. Thirty-six articles were included in the study, containing data on 72 discrete populations from 11 countries between 1987 and 2003, representing over 200,000 individuals. Studies on data collected prior to 1996 generally found either no association or the highest risk of HIV infection among the most educated. Studies conducted from 1996 onwards were more likely to find a lower risk of HIV infection among the most educated. Where data over time were available, HIV prevalence fell more consistently among highly educated groups than among less educated groups, in whom HIV prevalence sometimes rose while overall population prevalence was falling. In several populations, associations suggesting greater HIV risk in the more educated at earlier time points were replaced by weaker associations later. DISCUSSION: HIV infections appear to be shifting towards higher prevalence among the least educated in sub-Saharan Africa, reversing previous patterns. Policy responses that ensure HIV-prevention measures reach all strata of society and increase education levels are urgently needed.
OBJECTIVE: To assess the evidence that the association between educational attainment and risk of HIV infection is changing over time in sub-Saharan Africa. DESIGN AND METHODS: Systematic review of published peer-reviewed articles. Articles were identified that reported original data comparing individually measured educational attainment and HIV status among at least 300 individuals representative of the general population of countries or regions of sub-Saharan Africa. Statistical analyses were required to adjust for potential confounders but not over-adjust for variables on the causal pathway. RESULTS: Approximately 4000 abstracts and 1200 full papers were reviewed. Thirty-six articles were included in the study, containing data on 72 discrete populations from 11 countries between 1987 and 2003, representing over 200,000 individuals. Studies on data collected prior to 1996 generally found either no association or the highest risk of HIV infection among the most educated. Studies conducted from 1996 onwards were more likely to find a lower risk of HIV infection among the most educated. Where data over time were available, HIV prevalence fell more consistently among highly educated groups than among less educated groups, in whom HIV prevalence sometimes rose while overall population prevalence was falling. In several populations, associations suggesting greater HIV risk in the more educated at earlier time points were replaced by weaker associations later. DISCUSSION: HIV infections appear to be shifting towards higher prevalence among the least educated in sub-Saharan Africa, reversing previous patterns. Policy responses that ensure HIV-prevention measures reach all strata of society and increase education levels are urgently needed.
Authors: Linda-Gail Bekker; George Alleyne; Stefan Baral; Javier Cepeda; Demetre Daskalakis; David Dowdy; Mark Dybul; Serge Eholie; Kene Esom; Geoff Garnett; Anna Grimsrud; James Hakim; Diane Havlir; Michael T Isbell; Leigh Johnson; Adeeba Kamarulzaman; Parastu Kasaie; Michel Kazatchkine; Nduku Kilonzo; Michael Klag; Marina Klein; Sharon R Lewin; Chewe Luo; Keletso Makofane; Natasha K Martin; Kenneth Mayer; Gregorio Millett; Ntobeko Ntusi; Loyce Pace; Carey Pike; Peter Piot; Anton Pozniak; Thomas C Quinn; Jurgen Rockstroh; Jirair Ratevosian; Owen Ryan; Serra Sippel; Bruno Spire; Agnes Soucat; Ann Starrs; Steffanie A Strathdee; Nicholas Thomson; Stefano Vella; Mauro Schechter; Peter Vickerman; Brian Weir; Chris Beyrer Journal: Lancet Date: 2018-07-20 Impact factor: 79.321
Authors: Benson Singa; Sara Nelson Glick; Naomi Bock; Judd Walson; Linda Chaba; James Odek; R Scott McClelland; Gaston Djomand; Hongjiang Gao; Grace John-Stewart Journal: Sex Transm Dis Date: 2013-02 Impact factor: 2.830
Authors: John S Santelli; Zoe R Edelstein; Sanyukta Mathur; Ying Wei; Wenfei Zhang; Mark G Orr; Jenny A Higgins; Fred Nalugoda; Ron H Gray; Maria J Wawer; David M Serwadda Journal: J Acquir Immune Defic Syndr Date: 2013-07-01 Impact factor: 3.731