title: Does increased general schooling protect against HIV infection? A study in four African cities.
abstract: BACKGROUND
  The association between educational attainment and risk of HIV infection varies between populations and over time. Earlier studies in sub-Saharan Africa have found that those with more education are at increased risk of HIV infection.
  
  
  METHODS
  We investigated the associations between general schooling and both HIV and herpes simplex-2 (HSV-2) infection using data from the multicentre study on factors determining the differential spread of HIV in four African cities. Cross-sectional general population studies were conducted in 1997-1998 in Cotonou (Benin), Yaoundé (Cameroon), Kisumu (Kenya), and Ndola (Zambia), including about 2000 adults in each city.
  
  
  RESULTS
  There was no association between schooling and HIV infection in men or women in Kisumu or Ndola. Women in Yaoundé and men in Cotonou, with more schooling, were less likely to be HIV positive. These associations persisted after adjusting for sociodemographic factors. Similar trends in men in Yaoundé and women in Cotonou were not statistically significant. Increased schooling was associated with significantly decreased risk of HSV-2 infection in women in Kisumu and Ndola and men in Cotonou. In all the cities those with more education tended to report less risky sexual behaviour.
  
  
  CONCLUSIONS
  There was no evidence of an increased risk of HIV infection associated with education as seen in earlier studies. In each city there was some evidence of lower HIV or HSV-2 infection rates and less risky sexual behaviour associated with increased education levels. The most educated may be responding more readily to health education programmes. The challenge is to extend this to the rest of the population.
authors.affiliation: Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK. judith.glynn@lshtm.ac.uk
authors.forename: Judith R
authors.initials: JR
authors.lastname: Glynn
authors.forename: Michel
authors.initials: M
authors.lastname: Caraël
authors.forename: Anne
authors.initials: A
authors.lastname: Buvé
authors.forename: Séverin
authors.initials: S
authors.lastname: Anagonou
authors.forename: Léopold
authors.initials: L
authors.lastname: Zekeng
authors.forename: Maina
authors.initials: M
authors.lastname: Kahindo
authors.forename: Rosemary
authors.initials: R
authors.lastname: Musonda
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001541:Benin / Q000453:epidemiology; D002163:Cameroon / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006558:Herpes Genitalis / Q000453:epidemiology*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D012725:Sexual Behavior; D015024:Zambia / Q000453:epidemiology