Have the Educated Changed HIV Risk Behaviors More in Africa?

Abstract

Theory predicts that when new health information becomes available, more educated individuals may adopt healthy behaviors sooner, resulting in lower morbidity and mortality among the highly educated. This may be the case for HIV in sub-Saharan Africa: Recent empirical work shows that incidence is falling and the reduction is concentrated in more educated populations. However, it is unclear whether the educated have indeed adopted HIV risk-reducing behaviors to a greater extent than the less educated. I use two rounds of Demographic and Health surveys in eight African countries to examine whether HIV-related behavioral change over time is greater among the more highly educated. I examine changes in condom use, age of marriage, number of partners, extra-marital partnerships, and HIV testing. I find that education has a robust positive association with condom use and HIV testing, but also with having more sexual partners. I find that the probability of HIV testing increased more between rounds among the more educated, relative to the less educated. More educated men also appear to have larger reductions in the number of sexual partners and there is evidence that younger, more educated women may be marrying earlier than their predecessors did. The education gradient does not change significantly over time for condom use. These changes in behavior may signal a shift of the future burden of the epidemic towards more marginalized and less educated populations.