Investing In Secondary Schooling To Reduce HIV Risk

投资中学教育以降低艾滋病毒风险

• 批准号: 10004115
• 负责人: Jacob Bor
• 金额: $ 8.25万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10004115
• 关键词: AIDS prevention; Access to Information; Acquired Immunodeficiency Syndrome; Address; Adolescence; Adolescent HIV risk; Affect; Africa South of the Sahara; Age; Attitude; Behavior; Behavioral; Behavioral Mechanisms; Biological Markers; Birth; Botswana; Censuses; Correlation Studies; Data; Data Collection; Data Set; Dependence; Development; Distal; Econometric Models; Economics; Education; Educational Background; Exposure to; Female Adolescents; Fertility; Foundations; Future; Gender; Goals; HIV; HIV Infections; HIV risk; Health; Health behavior; Household; Human immunodeficiency virus test; Incidence; Income; Inequality; Intervention; Investments; Knowledge; Labor Forces; Lead; Length; Life; Life Cycle Stages; Light; Link; Marriage; Measures; Natural experiment; Outcome; Paper; Pathway interactions; Policies; Population; Prevention strategy; Production; Public Health; Randomized; Reproductive Health; Research; Risk; Risk Behaviors; Risk Reduction; Schools; Secondary Schools; Secondary to; Sex Behavior; Sexual Abstinence; Sexual Health; Sexual Partners; Structure; Surveys; Testing; USAID; Vaccines; Variant; Woman; Work; base; behavior change; child bearing; cohort; condoms; critical period; delay sexual debut; design; econometrics; effective intervention; empowerment; experience; global health; health economics; health literacy; human capital; infection rate; infection risk; innovation; labor force participation; population based; population survey; preference; secondary analysis; sex; sexual risk taking; skills; social; statistics; young woman

Project Summary Secondary education has been hailed as a “social vaccine” against HIV acquisition, particularly for young women who continue to experience high HIV incidence in sub-Saharan Africa. Education may provide HIV information, health literacy, and economic empowerment, reducing risks of transactional sex. Yet until recently evidence on the relationship between education and HIV risk was limited to correlational studies, vulnerable to confounding. In a recent paper in Lancet Global Health, we evaluated a natural experiment in Botswana, generating some of the first causal evidence linking education levels to reduced HIV infection rates. In 1996, Botswana changed the grade structure of secondary school, shifting grade 10 from senior secondary to junior secondary. Because there are many more junior secondary schools, this policy sharply reduced distance to the nearest grade 10 classroom and resulted in a 0.8-year increase in total years of schooling for affected birth cohorts. Exploiting this exogenous variation in education, we found that birth cohorts entering secondary school in or after 1996 had significantly lower risk of HIV infection when contacted in later population-based biomarker surveys. One additional year of schooling resulting from the reform reduced the 10-year cumulative incidence of HIV from 25% to 18%. Our findings were cited by PEPFAR/USAID in allocating over $100M to support secondary school expansion for HIV prevention, as part of the DREAMS initiative and the recently announced Secondary Education Expansion for Development (SEED) initiative. Building on this foundation, this R03 proposal for “Secondary Analyses of Existing Datasets” will determine the proximate behaviors (Aim 1) and the distal mechanisms for behavior change (Aim 2) that explain the impact of Botswana’s schooling reform on reduced HIV acquisition. To implement the proposed research, we have compiled a rich array of secondary datasets not available to us in our original study, including all four waves of the Botswana AIDS Impact Survey, four Botswana Censuses, and two Botswana Labor Force Surveys, which provide measures of proximate and distal mechanisms. We will analyze the data using the same econometric approach that we implemented in our original study. Our hypothesis is that secondary schooling shifted fertility and labor market preferences, leading to economic independence and lower HIV risk. There is a critical need to understand the mechanisms through which secondary education reduces HIV risk. The proposed research will shed light on whether the lessons from Botswana can be generalized to other settings and what mechanisms should be targeted by future education reforms for maximum HIV impact.

项目摘要 中等教育被称为反对艾滋病毒收购的“社会疫苗”，特别是对于年轻人而言 在撒哈拉以南非洲继续经历高艾滋病毒发病率的妇女。教育可能会提供艾滋病毒 信息，健康素养和赋权，减少了交易性别的风险。直到最近 有关教育与艾滋病毒风险之间关系的证据仅限于相关研究，很容易受到影响 混淆。在最近在《柳叶刀》全球健康方面的论文中，我们评估了博茨瓦纳的一项自然实验， 产生一些将教育水平与降低艾滋病毒感染率联系起来的第一个因果证据。 1996年，博茨瓦纳（Botswana）改变了中学的年级结构，将10年级从高级中学转移 到初中。因为还有更多的初中，所以这项政策大幅减少 距离最近10年级的教室的距离，导致学历的总年度增加了0.8年 受影响的出生队列。利用这种教育的这种外源性差异，我们发现出生队列进入 与1996年或之后的中学或之后联系时，稍后接触艾滋病毒感染的风险明显降低 基于人群的生物标志物调查。改革导致的另外一年的教育减少了 艾滋病毒的10年累积事件从25％到18％。我们的发现是由Pepfar/USAID引用的 作为梦中的一部分 倡议和最近宣布的中等教育发展（SEED）倡议。 在此基础的基础上，此R03提案“现有数据集的次要分析”将确定 近端行为（AIM 1）和行为改变的远端机制（AIM 2）解释了 博茨瓦纳的学校改革对减少艾滋病毒收购的影响。为了实施拟议的研究，我们 在我们的原始研究中，已经编译了我们无法使用的丰富的辅助数据集，包括所有四个 博茨瓦纳艾滋病冲击调查，四次博茨瓦纳人口普查和两名博茨瓦纳劳动力的浪潮 调查提供了近距离和识别机制的措施。我们将使用 我们在原始研究中实施的相同经济方法。我们的假设是次要 教育改变了生育能力和劳动力市场的偏好，导致经济独立性和降低艾滋病毒风险。 迫切需要了解中学教育减少的机制 艾滋病毒风险。拟议的研究将阐明博茨瓦纳的课程是否可以推广到 其他环境以及未来的教育改革应针对最大的艾滋病毒影响的哪些机制。