Abstract
While multiple studies have documented shifting educational gradients in HIV prevalence, less attention has been given to the effect of school participation and academic skills on infection during adolescence. Using the Malawi Schooling and Adolescent Study, a longitudinal survey that followed 2,649 young people aged 14–17 at baseline from 2007 to 2013, we estimate the effect of three education variables: school enrolment, grade attainment, and academic skills—numeracy and Chichewa literacy—on herpes simplex virus type 2 (HSV-2) and HIV incidence using interval-censored survival analysis. We find that grade attainment is significantly associated with lower rates of both HSV-2 and HIV among girls, and is negatively associated with HSV-2 but not HIV among boys. School enrolment and academic skills are not significantly associated with sexually transmitted infections (STIs) for boys or girls in our final models. Efforts to encourage school progression in high-prevalence settings in sub-Saharan Africa could well reduce, or at least postpone, acquisition of STIs.
Highlights
Over the last few decades, educational participation has expanded considerably in subSaharan Africa (African Development Bank Group 2011, 2014; UNESCO 2011)
The analysis reported here, based on a longitudinal sample conducted in two southern districts in Malawi, finds evidence that the greater the grade attainment in adolescence, the less likely a girl is to be infected with herpes simplex virus type 2 (HSV-2) or HIV and the less likely a boy is to be infected with HSV-2
How might we interpret the effect of grade attainment, given that academic skills and enrolment in school are not as consistently associated with infection in multivariate models? Undoubtedly, adolescents who continue to progress to higher grades differ from their counterparts with lower attainment; they may be more ambitious, better behaved in school, more studious, and less likely to be absent, and may have greater educational expectations, attributes likely associated with less sexual activity, for girls for whom engaging in sexual activity while enrolled in school is potentially more consequential than it is for boys (Kirby 2002; Frye 2012)
Summary
Over the last few decades, educational participation has expanded considerably in subSaharan Africa (African Development Bank Group 2011, 2014; UNESCO 2011). Studies have investigated whether there is an association between adolescent school participation and both HIV and herpes simplex virus type 2 (HSV-2) infection (see, e.g., Hargreaves, Bonell, et al 2008; Doyle et al 2013; Santelli et al 2015; Mee et al 2018) These studies have established the association between both HIV and HSV-2 infection and schooling, none of them have attempted to identify which dimensions of schooling may be most salient for sexually transmitted infection (STI) prevention nor have they considered how changes in adolescent educational characteristics may be associated with the incidence of new infections across the transition to adulthood. While many of those seropositive for HSV-2 never experience a clinical outbreak, prevention of infection has important consequences for public health, in low-income countries where suppressive therapy is not readily available
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