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The "education vaccine" against HIV

© 2002 Current Issues in Comparative Education, Teachers College, Columbia University, ALL RIGHTS RESERVED
6 December 1, 2000
The "Education Vaccine" Against HIV
Jan Vandemoortele
Enrique Delamonica
Evidence is emerging that the social profile of the AIDS pandemic is changing over time.
During its initial stage, the more educated, mobile and better-off members of society
seem to be most vulnerable to HIV infection. With increased information, knowledge
and awareness, however, their behavior changes faster than that of illiterate and poor
people in terms of delaying first sexual encounter, reducing the number of partners,
increasing condom use, and other actions to decrease risk of infection.
Relatively little has been published on the socio-economic correlates of HIV infection. A
few studies have shown higher prevalence rates at higher levels of income (Over & Piot,
1993, p. 464). This article attempts to fill some of the void in the existing literature. It
focuses on the correlation between HIV infection and the level of education, the latter
being a good proxy indicator for a person's overall socio-economic status. If the
hypothesis holds true that, beyond the initial stage of the AIDS pandemic, education
reduces the risk of HIV infection, then new HIV infections will gradually become
concentrated among illiterate and poor people as the epidemic spreads among the
The hypothesis implies that education is the best available protection against HIV
infection. Indeed, the "education vaccine" against HIV is likely to be the only one
available for the foreseeable future. This article discusses the way "education vaccine"
works. Furthermore, it provides some direct and indirect evidence in support of the
changing social profile of the disease and highlights the significance of the empirical
Education and HIV Infection
An inverse association between the disease burden and the level of education exists for
most infectious diseases. The incidence of malaria and cholera, for instance, are known
to be negatively associated with the level of education. But because of its main
propagation channel, HIV/AIDS first affects those with more opportunities, including
more educated, mobile and better-off people. Beyond the initial stage, the disease
burden quickly follows the normal pattern of other contagious diseases. Particularly in
the case of HIV/AIDS, the segments in society that are initially most vulnerable are also
best equipped to protect themselves and change their behavior. Thus, the argument
about the "education vaccine" is already obvious from existing evidence for other
infectious diseases. It is often said that people who wear a tie do not get cholera. In the
case of HIV/AIDS, education is likely to determine a person's vulnerability to HIV
The "Education Vaccine" Against HIV
Current Issues in Comparative Education, Vol. 3(1) 7
Some studies contest the validity of the "education vaccine" against HIV (Hargreaves &
Glynn, 2000). Those that lump together evidence from countries that are at very different
stages of the HIV pandemic will not capture the changing profile of the disease. If the
evidence of countries that are at different stages of the pandemic-such as Botswana and
Bolivia or Malawi and Malaysia1 - are lumped together for analytical purpose, then it is
unlikely that a clear pattern will be discernible between the level of education and the
HIV prevalence rate.
Studies based on data for the late 1980s and early 1990s-when the pandemic was
emerging-mostly show a direct and positive relationship between the level of education
and the prevalence rate2. More recent studies, however, no longer show a positive
correlation between education and HIV infection. Some are beginning to show a
negative correlation (Mnyika et al., 1996; Konde-Lule et al., 1997).
If the social profile of the pandemic changes as infection spreads, then in countries
where the HIV prevalence rate is low, surveys are likely to show an inverse correlation
between education and the risk of HIV infection. In countries with high levels of HIV
infection, surveys are likely to indicate a positive correlation. In countries with
intermediate HIV prevalence rates, surveys are likely to show a weak correlation or no
correlation at all between education and HIV infection. Thus, when evidence from
countries that are at different stages of the AIDS pandemic is pooled, no clear pattern
between education and HIV infection is likely to emerge.
What the evidence does not allow us to conclude is exactly how the 'education-vaccine'
against HIV works. Some argue that it works mainly through AIDS information and sex
education at school. Others believe that basic education is more important as it equips
and empowers a person-especially young women-to understand and internalize
relevant information and to translate knowledge into behavioral change. The spread of
education also changes the family and community environment in which such
behavioral change become socially acceptable. Indeed, young women who want to
protect themselves against HIV must often change their behavior in ways that conflict
with traditional values and customs.
In many countries, open and frank discussions about HIV transmission at home, in
school or in public are still challenged by a wall of silence that surrounds the disease.
The four allies that make the virus so prevalent in many developing countries all start
with 's'. They are silence, shame, stigma and superstition. These four "S's thrive in a
climate of ignorance and illiteracy. Education is key to defeating this deadly alliance.
Both AIDS-specific information and basic education are likely to play a role.
Disentangling their relative importance is difficult, if not impossible because AIDS-
specific information is more easily absorbed by literate people and because basic
education helps to address the four S's even without AIDS-specific information. Both
types contribute to behavioral change that reduces the risk of HIV infection.
Knowledge about HIV/AIDS
Since the early 1990s, Demographic and Health Surveys (DHS) have regularly
incorporated questions related to the knowledge about HIV/AIDS. Our analysis of 32
such surveys indicates that nearly one in every two illiterate women is ignorant about
Jan Vandemoortele and Enrique Delamonica
8 December 1, 2000
the basic facts about HIV/AIDS. Their lack of minimum knowledge about AIDS is about
five times higher than that for women with post-primary education (Figure 1). Among
those with basic knowledge about the disease, illiterate women are three times more
likely to think that a healthy-looking person cannot be sero-positive. Their belief that
there is no way to avoid AIDS is about four times higher compared with their educated
counterparts. The proportion of women who do not know that the HIV virus can be
transmitted from mother to child is, on average, three times higher for uneducated
women than for those with post-primary schooling3.
Figure 1. Women's ignorance about HIV/AIDS by level of education
Evidently, cross-country averages hide huge differences. In Peru, for instance, women
are three times more likely to lack basic knowledge about HIV/AIDS than women in
Uganda-a country with a long-standing public campaign about HIV/AIDS (Kaleeba et
al., 2000). But the difference between these two countries is most striking for illiterate
women. Nearly eight in ten illiterate women in Peru do not know about AIDS, against
only one in ten in Uganda. The difference between the two countries for women with
post-primary education is not as striking-11 and three percent respectively, according to
the data in their DHS.
Similarly, the two surveys (1994 and 1997) in Indonesia that collected AIDS-related
information show improved knowledge about AIDS between 1994 and 1997. However,
progress was only observed among educated women, whereas their illiterate
counterparts saw no improvement at all in their knowledge about HIV/AIDS. In short,
the Demographic and Health Surveys evidence is compelling. Without any exception, all
32 countries that were surveyed in the middle 1990s show a uniform pattern: knowledge
about the various aspects of HIV/AIDS increases with higher levels of education.
The "Education Vaccine" Against HIV
Current Issues in Comparative Education, Vol. 3(1) 9
Child Mortality
The changing profile of the pandemic is also reflected in mortality rates. DHS surveys in
Kenya, for instance, show that the average under-five mortality rate (U5MR) increased
from 91 to 105 per 1,000 live births between the 1989 and 1998. But Figure 2 indicates
that the impact was not the same for all Kenyan children. Children whose mother had
no education or did not complete primary school, saw their risk of premature death rise
by a staggering 45 per cent. Children whose mother had post-primary education, on the
other hand, continued to see a fall in their U5MR.
Figure 2. Widening mortality gap in Kenya (U5MR by level of maternal education)
In a period of less than 10 years, the disparity in the risk of premature mortality between
these two groups of children soared from 1.5 to 2.3. Similarly, widening disparities
between rich and poor children in terms of infant mortality and child malnutrition have
been documented for other countries (Sahn, Stifel & Younger, 1999). After decades of
steady decline, the increase in U5MR in Kenya is likely to be related to the HIV/AIDS
pandemic4. If so, the differential increase in U5MR by level of maternal education points
towards the effectiveness of the "education vaccine" against HIV.
Sero-Prevalence and Education
DHS surveys indicate the person's knowledge about AIDS by level of education and the
level of maternal education of children who die before their fifth birthday. They do not
report actual HIV infection rates by level of education. Thus, they provide suggestive
evidence about the "education vaccine" against HIV. To probe this impact of education
further, we examined the results of small-scale surveys in Zambia and Uganda that
report the education level of sero-positive people.
A 1994 sentinel survey in Zambia (Figure 3) shows a positive correlation between sero-
prevalence and education among pregnant women aged 25-29 (Fylkesnes et al. b, 1997).
At face value, this might contradict our argument about the "education vaccine" against
HIV, but it must be recalled that women who belonged to that age group in 1994-the
Jan Vandemoortele and Enrique Delamonica
10 December 1, 2000
year of the survey-became sexually active in the early and mid-1980s. That was the time
when little was known about the spread of HIV. The positive correlation actually
confirms that educated and better-off people are more vulnerable to HIV infection
during the initial stage of the pandemic than illiterate people are.
Figure 3. HIV infection rate among young women by level of education
However, the correlation between sero-prevalence and education was no longer
observed for the age group 15-19, the group that became sexually active a decade later
when information on the pandemic was more widespread. The survey suggests that
educated women started to change their behavior in the 1990s based on information and
knowledge. A steep reduction in their average infection rate was observed both in urban
and rural areas. By contrast, the HIV prevalence rate among women without education
remained relatively constant5.
A sentinel survey of childbearing women in a town in Western Uganda provides further
evidence of the changing social profile of the AIDS pandemic (Kilian et al., 1999).
Uganda is a country where strong public information campaigns have been used since
the mid-1980s in an effort to reduce new HIV infections. Implemented under a slogan of
'Faithfulness, Abstinence, Condoms,' the efforts of these information campaigns are now
paying off. In 1987, there were an estimated 239,000 new cases of HIV/AIDS each year.
By 1997, the figure had fallen to 57,000 (UNICEF, 1999, p. 19). But even in this
exceptional case, the positive impact on the poor-those with little or no education-has
been the least.
Figure 4 shows that in the period 1991-94, young women (age 15-24) with secondary
education were still more likely to be infected than their illiterate counterparts albeit that
the positive association between education and HIV infection was already weaker than
in the case of Zambia for the age cohort 25-29, as shown in Figure 3. But the positive
association between the level of education and the rate of HIV infection was no longer
observed in 1995-97. The relationship was actually reversed during the 1990s due to
The "Education Vaccine" Against HIV
Current Issues in Comparative Education, Vol. 3(1) 11
behavioral change among educated women, such as condom use, delayed first sexual
encounter and fewer partners (Kilian et al, 1999, p. 397; Blanc, 2000, p. 17). The HIV
infection rate among educated women dropped by almost half, whereas it fell less
steeply for women without formal schooling.
Figure 4. HIV infection rate among pregnant women by level of education
The evidence presented in this article seems to confirm the hypothesis that the social
profile of AIDS pandemic is changing. The disease is increasingly discriminating against
illiterate and poor people. This underscores the urgency for achieving universal primary
education with a view to equipping the poor with basic capabilities to protect
themselves against HIV infection. It also implies that public awareness campaigns need
to be devised so as to reach the illiterate and less educated people and to be understood
by them.
Above all, the changing social profile of the AIDS pandemic makes a compelling case for
using education as one of the most powerful tools for slowing and reversing the spread
of HIV. Girls' education appears as an absolute priority. Recent studies in Africa show
that teenage girls are five to six times more likely to be infected by the HIV virus than
boys are their age (UNAIDS, 1999, p. 15). Moreover, gender-specific infection rates seem
to be closely related to the overall HIV prevalence rate. At low prevalence levels, the
infection rate among male adolescents is higher than among females; but young females
become the most vulnerable group in society when the country reaches a high
prevalence rates. In Peru, for instance, young males (ages 15-24) are twice as likely to be
sero-positive as young females their age (0.4 and 0.2 percent respectively). In Lesotho,
however, HIV infection among girls is twice as high as for boys (26 and 12 per cent
respectively) (UNICEF, 2000, p. 4-5). In most countries, adolescent females are
disproportionately represented among the newly infected people.
Jan Vandemoortele and Enrique Delamonica
12 December 1, 2000
The implication of the changing social profile of the pandemic is far-reaching. A disease
that affects predominantly poor and illiterate people is unlikely to generate the same
level of political commitment and public resources as a disease, which does not
discriminate against the poor. This is valid both at the international and national levels.
For example, research and development on diseases that occur only in developing
countries often fail to attract much attention and resources. For example, out of 1,223
new chemical entities that were developed between 1975 and 1997, only 13 treated
tropical diseases (Pecoul, Chirac, Trouiller & Pinel, 1999).
Once AIDS is perceived as a disease that predominantly affects the poor, then public
commitment to find a cure or a vaccine or to support public awareness campaigns could
be in jeopardy. When the non-poor no longer feel they have a stake in such efforts, the
voice of the poor and the illiterate alone is unlikely to be strong enough to maintain
public support and strong political commitment. Susan George (1999) makes this point
obvious: "As the disease [AIDS] moves inexorably down the social scale, the
'biopolitician' will learn that few votes are garnered by funding programmes for the
dregs of humanity" (p. 145).
At the same time, the above evidence provides a glimmer of hope in an otherwise
gloomy context. Indeed, the good news is that HIV infection rates are declining among
people with primary and post-primary education, even in countries where the overall
HIV prevalence rate is still on the rise. Similarly, the good news in Kenya is that the risk
of premature death continued to decline for children whose mother had post-primary
education during the 1990s, in spite the increase in the country's average U5MR. Such
positive aspects deserve to be highlighted, because a world without hope offers few
opportunities for improvement.
1. 1 At the end of 1999, the proportion of adults (ages 15-49) living with HIV/AIDS was
estimated at 36 per cent in Botswana and 0.1 per cent in Bolivia; at 16 per cent in
Malawi and 0.42 per cent in Malaysia.
(, October 31, 2000)
2. These studies include evidence from Tanzania, Uganda and Zambia. Most, but not
all, properly take into account other factors such as age and sexual behavior.
3. The differences between the (unweighted) averages for two education groups in the
32 surveys-no education and post-primary education-are statistically significant.
4. The latest data show that 14 per cent of Kenya's young women (15-24 years) are HIV-
positive (UNICEF, 2000, p. 4).
5. 5 It could be argued that the difference between the two age groups does not
necessarily suggest a change in behavior, but that it simply reflects a lower level of
sexual activity among adolescents. However, DHS surveys for Zambia have shown
that the majority of girls become sexually active before age 18, irrespective of their
level of education.
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... When discussing the impact of HIV/AIDS on education systems, many authors (Carr-Hill & Peart, 2003;Coombe, 2004;Fall, 2002;Gachuhi, 1999;Jukes & Desai, 2005;Kelly, 2oooa) distinguish between the impact on the demand side and the impact on the supply side. As for the demand side, reduced life expectancy, increased condom use and other social factors, result in a reduction of the average number of children per woman (Dorling, Shaw & Smith, 2006;Vandemoortele & Delamonica, 2000). In five countries that currently have adult HIV prevalence rates of over 20 per cent (South Africa, Zimbabwe, Botswana and Swaziland), the under-five mortality rate not only failed to decline between 1990 and 2003, it actually increased during that period (United Nations Department of Economic and Social Affairs, 2005). ...
... Traumas can affect students' learning ability. Even the environment of morbidity in general, and the visibility of the effects of the disease in the surroundings of the child, can create considerable stress (Vandemoortele & Delamonica, 2000). As a consequence, the education system is now faced with new groups of children and youths whose lives have been marked in some way by HIV/AIDS: orphans, children who are the head of household, street children and youths, children and youths who care for sick parents or relatives and children and youth infected with HIV. ...
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This paper discusses the role of education in preventing HIV in children and young people in sub-Sahara Africa and presents the results of policy advisory research conducted on behalf of the Belgian Development Cooperation. The research consisted of a literature review and a field study in Rwanda. Relative to the high number of HIV prevention activities in sub-Sahara Africa, there is a limited number of scientific data on HIV risk reduction interventions for young people in this region. Longitudinal studies are especially scarce. Preliminary results show that many interventions have only a marginal impact on reducing sexual risk behaviour. Factors influencing programme effectiveness include the consistency and accuracy of messages and information, the provision of life-skills, social support and access to contraceptives, the intensity and duration of the programme, the training of the facilitators and the age of the target population. The HIV/AIDS pandemic has a potentially devastating impact on the education sector. Because few countries have monitoring systems in place that quantify the absenteeism, morbidity and mortality of teachers and students infected with or affected by HIV/AIDS, there is only anecdotal evidence available for illustrating this impact. The final section discusses the current gaps in research and the important role of theory in increasing the impact and improving the evaluations ofl IIV/AIDS education interventions.
... Demographic and socioeconomic variables include age and education level, which have shown to impact HIV incidence. 11,37,38 Biological variables include two variables representing aspects of an individual's STI history. STIs like gonorrhea, chlamydia, and syphilis have been shown to increase likelihood of HIV infection. ...
... From prior literature, we know these variables have been shown to be meaningful indicators of HIV risk both in the population as a whole and among MSM specifically. 11,22,23,37,40,41,48,49 As such, the predictors that were not significant in our models should be interpreted as factors that we recognize as clinically relevant indicators of HIV risk, but not as the best statistical indicators among the YBMSM in our samples. ...
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HIV burden in the United States is geographically and demographically heterogeneous. While efforts over the last few decades have reduced HIV incidence, young black men who have sex with men (YBMSM) account for a significant portion of new HIV diagnoses compared to any other race and age group. The Centers for Disease Control and Prevention has allocated funding to help reduce HIV in the YBMSM community; however, their recommended screening/treatment criteria do not emphasize demographic specificity. To better guide more applicable screening guidelines specifically for YBMSM, we examine demographic, behavioral, sexual network, and biological predictors of HIV status among YBMSM in two demographically distinct cities with high HIV burden in the United States: Chicago, IL and Los Angeles, CA. We perform multivariable logistic regressions to identify predictors of HIV in these populations. We found that having a history of syphilis was the only statistically significant predictor across both cities despite inclusion of other characteristics previously shown to be associated with HIV among YBMSM. Syphilis history could be a powerful HIV risk indicator for YBMSM and, therefore, should be integrated into clinical screening practices for critical biomedical prevention options like HIV pre-exposure prophylaxis.
... Our results are closer to those of (Behrman, 2015;De Walque, 2007;Pettifor et al., 2005) who find that education reduces the probability of being HIV positive. In fact, an extensive literature on "education as a vaccine of HIV" suggests that education is the best available protection against HIV infection (Jukes et al., 2008;Vandemoortele & Delamonica, 2000). Using a randomised evaluation involving 328 schools in western Kenya, Duflo et al. (2015) show that the implementation of an Education Subsidy program, combined with an HIV Education program in Kenya, has reduced girls 0 school dropout, early pregnancy and STI infection. ...
Women remain disproportionately affected by HIV in sub-Saharan Africa. Although there is unanimous agreement on the positive impact of schooling in reducing the pandemic, measuring the extent of this impact remains empirically difficult. Using data from the 2018 round of Zambia’s Demographic and Health Survey (DHS), we took advantage of the free primary education reform that abolished school fees for grades one to six in 2002 to obtain an exogenous variation in women’s education levels. We estimate a three-equation model to assess consistent estimates of the impact of education on a woman’s probability to be HIV positive. When the problems of sample selection and endogeneity are not addressed, we find that the effect of education on HIV status is greatly underestimated. After controlling for these two sources of bias, the effect having a secondary education on the risk of being seropositive doubles when compared to the uncorrected results. This result suggests that women acquire agency through education to prevent HIV infection. Pathways to these effects include contraceptive use, the number of lifetime sexual partners and marital status. Hence, policy makers and practitioners in Zambia should invest substantial efforts in promoting girls’ education in order to reduce the prevalence of HIV/AIDS among women.
... However, even if this training is provided to learners in later stages of life, it is never too late. It still enables making a difference, imparting relevant skills which can be applied in the context of a more intimate connection with family life, the responsibilities of each individual in society, the problems that the individual learner faces, and can address how they, as members of a family or other collective entity, are required to take co-responsibility in times of national disaster (Vandemoortele and Delamonica 2000). Allowing children back to school requires intensive interventions to prepare these learners to return to the public space. ...
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In combating pandemics, more can be gained by changing citizens’ behaviours than by relying solely on the medical route. In the current COVID-19 pandemic, the struggle to contain the outbreak and push back new infection figures will ultimately be won by training citizens how to avoid creating secondary transmission chains. The COVID-19 pandemic highlights the relationship between individual behaviour and group risk. Mass training of all social strata of a country’s entire population is therefore critical in mitigating the pandemic. The authors of this article argue that adult learning and education (ALE) can play a pivotal role particularly in countries where average literacy levels are low, as these are usually the same countries in which healthcare systems are more fragile. This article explains why ALE, especially the promotion of health literacy as part of ALE (which is itself part of lifelong learning), is necessary to enable individuals to make informed health-related decisions. Research has shown that low- or non-literate individuals are less responsive to health education, less likely to use disease prevention services, and less likely to successfully manage chronic disease than literate citizens. The authors refer to the evaluation of the health literacy aspect of a large-scale adult literacy campaign launched in South Africa in 2008 which has yielded measurable outcomes and proved that the intervention had enabled adults to better understand health messages. They stress the importance of populations having at least a basic level of literacy and numeracy skills to enable them to receive and act on vital information during a pandemic or disaster. They argue that ALE should in fact be understood as an inherent element of every national emergency strategy, both in terms of prior preparation for possible future emergencies (such as pandemics, earthquakes, tornados, flooding, bushfires etc.), and in terms of reaction to a given emergency such as the current COVID-19 pandemic.
The education sector provides students with facts about HIV/AIDS which have emerged as major public health and socio-economic problems affecting students. The purpose of this study was to assess students’ knowledge on HIV/AIDS, attitudes towards AIDS education and its associated impacts on them and cultural sensitivity of the open discussion on HIV/AIDS. A total of 384 students in the age group 11-19 were selected by simple random sampling technique. A self-administered survey questionnaire and KIIs were used to collect the required data from the study participants. More than half of the students (54%) were selected from urban area and the rest were from rural area. The findings of the study suggest that a good number of students (37%) were found with high knowledge about HIV/AIDS. Again, a substantial number of students (61%) showed conservative attitudes towards AIDS education. Students of urban area were found with high knowledge and those who were the followers of Islam tended to show conservative attitudes towards AIDS education. The bivariate results indicate that location of educational institutions, section management, education, age, marital status and income were found significant association with level of knowledge. Again, location of educational institutions, type of institutions, section management, age, marital status, religion, income were found to be significantly associated with attitudes towards AIDS education and cultural sensitivity of the open discussion on HIV/AIDS. Moreover, binary logistic regression results on knowledge and attitude shows that students’ of urban educational institutions (OR=1.923) and students with higher level of education (OR=1.535) were more likely to have higher knowledge and students with greater age (OR=1.387), middle income group (OR=2.939) tended to be conservative. Again, students of rural area (OR=1.797) and the students who were the followers of Islam were more likely to consider the open discussion on HIV/AIDS as culturally sensitive. Results on impacts of AIDS education show that location of institution, type of institution, level of education, age, religion, love-affair with anyone, income and some AIDS education correlates such as discussing with friends, AIDS education as a regular part of curriculum etc. were also found significantly associated with positive effects of AIDS education. Moreover, students who discussed HIV/AIDS issues comfortably with their friends (OR=2.013) and those who reported AIDS education as a regular part of students’ curriculum (OR=1.931) were more likely to say that AIDS education through textbooks removed the misconceptions on HIV/AIDS compared to those who gave opposite answers.
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Globalization is a form of social change, reshaping the socio-spatial milieu in which humans strive, and in which health and disease are managed and controlled. And yet the effects of globalization are distributed unevenly, with opportunities open for some but not for all. Globalization, Health and the Global South is an important textbook for any student of this fascinating area. Examining the dynamics of globalization through the lens of the Global South, it highlights risks and vulnerabilities that affect different regions and contexts, exacerbating inequalities despite the continuing speed of global processes. The books takes a critical approach to the topic, offering readers a deep understanding of health discourses and discusses a range of key topics, including migrant health, the role of politics and diplomacy and the Coronavirus pandemic. Including further reading and end of chapter discussion questions, this essential textbook will be important reading for students across the health and social sciences.
The aim of this contribution is to determine the communicative efficacy of selected print-based HIV and AIDS information education and communication (IEC) materials (posters, leaflets and brochures) among secondary school teenagers (13–19 years) in Harare. Data were collected over a period of 2 months from six schools, selected using multistage cluster sampling. It incorporated use of a self-administered questionnaire involving a sample of 750 teenagers, and 6 focus group discussions (FGDs), each comprised of 10 purposefully sampled participants. The survey investigated a number of indicators of communicative efficacy, wherein the IEC materials were found to be clear by 38.4 per cent ( n = 288), informative by 45.2 per cent ( n = 339), credible by 80.5 per cent ( n = 604), appealing by 64.7 per cent ( n = 485), important by 69.5 per cent ( n = 521) and acceptable by 54 per cent ( n = 405) of the respondents. The outcomes of the FGDs showed that, although HIV and AIDS IECs were generally believed to be appealing and to significantly increase awareness among teenagers, these were also considered somewhat unclear and inaccessible. Moreover, perceptions were strongly inclined towards use of Shona language, social media and elimination of fear appeals in HIV information. Thus, in addition to adopting young people-centred communication modes, finding an appropriate balance between complex language and efficacy of HIV prevention messages is imperative.
An extensive field of research identifies girls’ secondary education as central to improving human and economic development. Despite improvements in girls’ secondary education enrollment, there are still over 34 million female adolescents out of school—the majority in developing nations. While gender equity in education has improved, girls still lag behind boys in secondary education enrollments. Building on existing research, we argue that the failures of education spending in creating equitable access to secondary education are due to a lack of governance. We contend that strong governance has the potential to increase the effectiveness of education expenditures at improving female secondary education relative to males. Using two-way fixed effects models for a sample of 105 low and middle-income nations from 1997 to 2012, we examine how the interaction between four measures of governance and education expenditures impact gender equity in secondary education. Our findings suggest that governance increases the effectiveness of education expenditures in improving girls’ secondary education enrollment compared to males.
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To examine socio-demographic HIV prevalence patterns and trends among childbearing women in Zambia. Repeated cross-sectional surveys. Personal interviews and unlinked anonymous testing of blood samples of women attending antenatal care in selected areas. The 1994 data includes information from 27 areas and a total of 11,517 women. The HIV prevalence among urban residents appeared with moderate variation at a very high level (range 25-32%, comparing provinces). The geographical variation was more prominent in rural populations (range 8-16%) and was approximately half the prevalence level of the urban populations. With the exception of the 15-19 years age-group, HIV infection was found to rise sharply with increasing educational attainment (odds ratio, 3.1; confidence interval, 2.6-3.8) when contrasting extreme educational levels. Although the assessment of trends is somewhat restricted, the available information indicates stable prevalence levels in most populations over the last 2-4 years. The data showed extremely high HIV prevalence levels among childbearing women. Longer time-intervals between surveys are needed, however, in order to verify the stability in prevalence identified by this study. The tendency to changing differentials by social status is suggested as a possible sign of an ongoing process of significant behavioural change.
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Drugs offer a simple, cost-effective solution to many health problems, provided they are available, affordable, and properly used. However, effective treatment is lacking in poor countries for many diseases, including African trypanosomiasis, Shigella dysentery, leishmaniasis, tuberculosis, and bacterial meningitis. Treatment may be precluded because no effective drug exists, it is too expensive, or it has been withdrawn from the market. Moreover, research and development in tropical diseases have come to a near standstill. This article focuses on the problems of access to quality drugs for the treatment of diseases that predominantly affect the developing world: (1) poor-quality and counterfeit drugs; (2) lack of availability of essential drugs due to fluctuating production or prohibitive cost; (3) need to develop field-based drug research to determine optimum utilization and remotivate research and development for new drugs for the developing world; and (4) potential consequences of recent World Trade Organization agreements on the availability of old and new drugs. These problems are not independent and unrelated but are a result of the fundamental nature of the pharmaceutical market and the way it is regulated.
Sexually transmitted diseases, including HIV infection The burden of all sexually transmitted diseases (STDs) in Sub-Saharan Africa is absolutely greater for females than it is for males, and it is growing. The causes and results of that burden remain dauntingly circular. The most important gender differentials are behavioral and biological. Females are far less likely than males to be able to control the circumstances of their sexual activity. Transmission of some STDs (including gonorrhea, chlamydia, trichomoniasis, and HIV) is more efficient to females than to males for physiological and sociocultural reasons. STDs may also predispose to other STDs, and they foster HIV transmission. Women with STDs are more frequently asymptomatic than men. When symptoms do manifest in females, they are often nonspecific, and this may delay the search for medical attention. When women do seek clinical care, they are less likely to be treated effectively since the very subtlety of symptoms can confound diagnosis, making treatment less effective. Infected women are also more likely to be stigmatized as prostitutes or, at best, as promiscuous, and treated poorly. All these factors promote the possibility of complications from STDs, including infertility or, worse, full-blown HIV infection, which carries great personal, family, and societal costs.
Last edition published in 2000.
Risk factors for HIV-1 infection among women were assessed through a population-based cross-sectional study in the Arusha region of northern Tanzania. The study participants were obtained by randomly selecting 10-household clusters from Unga limited, the town of Babati, and the roadside village of Matufa, which are urban, semi-urban, and rural communities, respectively. Informed verbal consent for participation in an interview and in HIV-1 testing was sought from each respondent. Blood samples were collected from each consenting individual for HIV-1 antibody testing using enzyme-linked immunosorbent assay (ELISA), and all positive sera were confirmed using repeated ELISA tests. Information of risk factors was obtained through the interview process using a structured questionnaire. Of the 567 women who gave blood samples, 48 (8.5%) were HIV-1 positive. The HIV-1 seroprevalence rates among women in the urban area, the semi-urban area, and the rural village were 14.4%, 6.9% and 2.3%, respectively. Factors associated with significantly higher HIV-1 seroprevalence were urban residence; history of having traveled out of the Arusha region within Tanzania, as well as having traveled abroad; having multiple sex partners; and having sexual intercourse under the influence of alcohol. Women who reported ever having used condoms had significantly higher probability of being infected with HIV-1 than those who had never used condoms, suggesting that condom use may be a marker of high-risk sexual behavior and that condom use is probably not adhered to in a way that consistently protects against HIV-1 infection. These results suggest the need for health education interventions aimed at increasing appropriate and consistent condom use and reduction of the number of sexual partners.
To describe the epidemiology of HIV-1 infection among adolescents aged 13-19 years, in rural Rakai district, Uganda. Baseline survey and 2-year follow-up (1990-1992) of adolescents in a population-based, open rural cohort. Annual enumeration and behavioral/serological survey of all consenting adolescents aged 13-19 years at recruitment, residing in 31 randomly selected community clusters. At baseline, of 909 adolescents present in study clusters, 824 (90.6%) provided interview data and serological samples. No adolescents aged 13-14 years were HIV-infected. Among those aged 15-19 years, 1.8% of men and 19.0% of women were HIV-positive. Among young women aged 15-19 years in marital/consensual union, 21.3% were HIV-positive; this rate did not differ significantly from the 29.1% prevalence in those reporting non-permanent relationships; prevalence was significantly lower in women reporting no current relationship (4.3%). After multivariate adjustment, female sex, age 17-19 years, residence in trading centers/trading villages and a history of sexually transmitted disease symptoms remained significantly associated with HIV infection. Seventy-nine per cent of adolescents provided a follow-up serological sample. No young men aged 13-14 years seroconverted during the study; in young women aged 13-14 years, HIV seroincidence was 0.6 per 100 person-years (PY) of observation. Among young men aged 15-19 years, there were 1.1 +/- 0.6 seroconversions per 100 PY of observation prior to age 21 years; among women 15-19 years, the incidence rate was 3.9 +/- 1.0 per 100 PY of observation prior to age 21 years. The mortality rate among HIV-positive adolescents aged 15-19 years, at 3.9 per 100 PY of observation, was 13-fold higher than that among the HIV-uninfected. By 1992, knowledge of sexual transmission was almost universal, the proportions reporting multiple partners had decreased and condom use had increased over baseline. Adolescents, and young women in particular, are vulnerable to HIV infection. Despite reported behavioral changes, HIV incidence rates remain substantial, and there is a need for innovative HIV preventive measures.
To monitor the HIV-1 epidemic in Western Uganda and the possible impact of interventions. Results from sentinel surveillance of HIV-1 seroprevalence were compared with cross-sectional serosurvey data and model simulations. Age-specific trends in HIV-1 prevalence between 1991 and 1997 amongst antenatal clinic (ANC) attenders in the town of Fort Portal, where a comprehensive AIDS control programme has been implemented since 1991, were analysed. Results were compared with outputs from a mathematical model simulating the HIV-1 epidemic in Uganda. Two scenarios were modelled: one without and one with behaviour change. Sentinel surveillance data were compared with data from a population-based HIV-1 serosurvey at the study site, which was carried out in early 1995. Data from 3271 ANC attenders identified greater education and being single as risk factors for HIV-1 infection. A significant decrease of risk for women with secondary school education over time was observed, whereas the risk for illiterate women remained high. Among women aged 15-19 years (n = 1045) education and marital status-adjusted HIV-1 prevalence declined steadily from 32.2% in 1991 to 10.3% in 1997. For 20-24-year-old women (n = 1010) HIV-1 prevalence increased until 1993 from 19.9% to 31.7% and decreased thereafter (21.7% in 1997). These trends closely follow the prediction of the model simulation assuming behaviour change, and for 1995-1997, confidence intervals of the HIV-1 prevalence estimate exclude the model output for an uninfluenced epidemic. No clear trends of HIV-1 prevalence were found in older women (n = 1216) and comparisons with the model were ambiguous. Sentinel surveillance data at the time of the population survey closely reflected results for the female general population sample for the two younger age-groups (15-19 and 20-24 years). In contrast, pregnant women aged 25-29 years showed significantly lower rates than the population sample (20.8% versus 45.1%). HIV-1 prevalence amongst ANC attenders aged 15-24 years can be used to monitor the HIV-1 epidemic in the given setting. Declining trends of HIV-1 prevalence in women aged 15-19 and 20-24 years most likely correspond to a reduced HIV-1 incidence attributable to changes in behaviour. Our data also show that sentinel surveillance data need to be age-stratified to give useful information.