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STUDY: Could an Extra Year of School Reduce HIV Risks?

STUDY: Could an Extra Year of School Reduce HIV Risks?


Researchers say that one year of additional education dramatically reduces someone's chance of acquiring HIV.

According to Voice of America, a new study suggests an extra year of  high school could reduce a person's risk of HIV infection by 33 percent. The authors say the study, published this month in The Lancet Global Health, shows that education is cost-effective method for preventing HIV, especially in lower income nations. 
Globally, more than two million people each year become HIV-positive. Voice of America reports that the African nation of Botswana has among the world’s highest HIV infection rates, where nearly a quarter of the population is HIV-positive.
Experts have long believed that those with higher educations are less likely to contract the disease, but the assertion has been difficult to prove. That's where Botswana comes in. Nearly two decades ago, in 1996, the country altered its educational system by transfering tenth grade to a junior secondary school. In Botswana, a junior secondary school education is essential for students to get jobs or continue on to vocational training.
“It made grade 10 much more accessible to people and increased the benefits for completing” the extra year, said the study's co-author Jacob Bor, a health economist at Boston University School of Public Health. Since the school previously ended at ninth grade, this change offered researchers a perfect real-world experiment regarding education and HIV transmission rates.
Bor and the other researchers examined the impact that extra year of schooling had years later. To do so, they compared Botswana's national health surveys taken in 2004 and 2008 and discovered that the effect was much larger than they'd expeted.  
“We were surprised how large they were,” Bor siad. They found that risk of HIV infection fell by more than eight percent — from 25.5 percent to 17.4 percent — in just four years. The effects were especially notable for women, who saw nearly 12 percent decline in HIV infections.
“I think that this study really provides evidence that we should consider formal schooling, particularly secondary schooling, as part of HIV prevention,” Bor argued.
The researchers also believe "secondary school was cost effective as an HIV prevention intervention by standard metrics," meaning that each HIV infection that was prevented cost about $27.  
“If we were to account for all the other benefits of schooling," Bor added, "then the cost-effectiveness would, I think, make it a slam-dunk.”
The Lancet also published comments by Karen Grepin, a New York University health economist. Grepin reviewed previous studies on education level and HIV, noting that a 2002 systematic review of studies found that "education was either not associated or was positively associated with HIV status, suggesting that more education might actually increase exposure to the virus."
But, as the virus left America's gay male population and spread across the globe those statistics started to change.
"A much larger 2008 review found that, although education and HIV were positively associated in earlier years, the disease burden now disproportionately falls on the less educated," wrote Grepin. “The primary reason (for education) isn’t for the health effects, but the health effects themselves can be large as well."
The researchers dont know exactly why additional education lowers HIV risk in Botswana.
“That’s, I think, one of the most fascinating pieces about this,” Bor said. “What we’re seeing is not the effect of HIV-specific education, but education more generally. Which then raises the question, what are people getting?”
More education may improve job prospects, especially for women in sub-Saharan Africa where, Bor said, they frequently “find themselves in economically dependent sexual relationships where they don’t necessarily have enough power in those relationships to insist on condom use or avoid risk in other ways.”
Additional schooling may also improve cognitive skills, helping those individuals make better decisions throughout their lives. Although Grepin found the Botswana study offered "important new insights into this important global health issue," she also concluded that it had several limitations.
First, she notes the surveys used were limited to individuals who volunteered and consented to an HIV test. Second, the study was unable to identify the effect of education on HIV risk over the subjects' entire lifetimes.
Still, Grepin wrote, "Increasing access to education in low-income countries should be an important priority because of the proven economic returns to such investments. The health returns from education, such as its potential role in HIV and child mortality should also make it a top priority for the global health community."
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