HIV infections appear to be concentrating among the least educated people in Africa, reversing previous patterns which saw higher levels of infection among the most educated, according to a study published today in the journal AIDS.
A team led by Dr. James Hargreaves of the London School of Hygiene & Tropical Medicine (LSHTM) sought to assess whether the profile of people infected with HIV is changing over time in sub-Saharan Africa.
HIV has spread rapidly in Africa, the world's poorest region, and is widely characterised as a disease of poverty. However, the situation is more complex than this. In 2001, an LSHTM team, also led by Dr. Hargreaves, found that before 1996, individuals with the highest levels of education were often more likely to be infected with HIV than less educated people, perhaps because they were wealthier, more mobile and had broader networks of sexual partners.
The new article updates this work and draws a different conclusion. The LSHTM team screened over 4000 research papers to identify relevant data collected all around the world, eventually identifying 36 studies conducted in 11 countries between 1987 and 2003 representing data on over 200,000 individuals.
They found that in data from after 1996 more studies found a lower risk of HIV infection among the most educated. Where data over time were available from the same place, HIV prevalence fell more consistently among highly educated groups than among less educated groups. HIV prevalence sometimes rose among the less educated even while it fell among the overall population.
Dr. Hargreaves comments: 'At the time of our initial review, we speculated that, as HIV education campaigns developed in sub-Saharan Africa, the most educated, empowered members of society would be the first to adopt protective behaviours such as reducing numbers of partners and using condoms. And since HIV campaigns are often delivered within schools, we also speculated that those who stayed in school longer might be exposed to more health education messages and as a result adopt protective behaviours. We predicted that, in the absence of effective interventions that engaged the least educated, HIV would, over time, increasingly become concentrated in this group.
'These results are partly good news. They confirm that HIV prevalence is falling, sometimes quite steeply, in some groups of people. This is probably at least partly because of the global response to the epidemic so far. But our new study also indicates that our fears were justified: HIV is increasingly becoming concentrated among the most vulnerable members of society. We conclude that more needs to be done to encourage educational achievement across the whole of society if we are to stem the tide of HIV infection in sub-Saharan Africa'.
Systematic review exploring time trends in the association between educational attainment and risk of HIV infection in sub-Saharan Africa. James R Hargreaves, Christopher B Bonell, Tania Boler, Delia Boccia, Isolde Birdthistle, Adam Fletcher, Paul M Pronyk, Judith R Glynn. London School of Hygiene & Tropical Medicine.
To interview Dr. Hargreaves, or to be sent a full copy of the paper, please contact the London School of Hygiene & Tropical Medicine Press Office on +44 (0)207 927 2073
1 Hargreaves JR, Glynn JR. Educational attainment and HIV-1 infection in developing countries: a systematic review. Trop Med Int Health 2002, 7:489-498.