title: Education attainment and the risk of HIV-1 infections in rural Kilimanjaro Region of Tanzania, 1991-2005: a reversed association.
abstract: OBJECTIVE
  Previous studies found educated individuals to have higher risk of human immunodeficiency virus (HIV)-1 infection in Africa. A reverse in this association was predicted. We investigated the change in this association from 1991 to 2005 in a rural population in Tanzania.
  
  
  METHODS
  Two cross-sectional surveys were conducted in 1991(N = 1,152, response rate 76.4%) and 2005 (N = 1,528, 73.0%). Consenting individuals aged 15 to 44 years living in Oria village were interviewed and gave blood for HIV-1 testing.
  
  
  RESULTS
  Primary [adjusted odds ratio (AOR), 2.7; 95% confidence interval (CI): 1.3-20.0] and secondary/higher education (AOR, 4.5; 95% CI: 1.4-24.9) were associated with increased risk of HIV-1 infection in 1991. A reversed association was observed in 2005 where reduced odds of infection were associated with primary (AOR, 0.5; 95% CI: 0.2-0.8) and secondary/higher education (AOR, 0.4; 95% CI: 0.3-0.9). This was most pronounced among educated men. Corresponding reduction in risk behaviors were observed. Increased odds of reporting ever use of condom (AOR, 2.8; 95% CI: 1.1-7.3) and 70% reduction in reporting >or=2 sexual partners in the past year was observed among educated women. Educated men reported 60% reduction in the odds of reporting >or=2 sexual partners in the past month preceding the last survey.
  
  
  CONCLUSIONS
  A reversed association between education attainment and HIV-1 infection was observed in this population between 1991 and 2005. Education seems to have an empowering role in women. Decreased risk among educated men may have an impact on HIV-1 transmission. Improving education sector in rural areas might be instrumental in the fight against the HIV epidemic.
authors: Department of Epidemiology and Biostatistics, Muhimbili University of Health Sciences, Tanzania. e.j.mmbaga@ulrik.uio.no
authors: Elia J
authors: EJ
authors: Mmbaga
authors: Germana H
authors: GH
authors: Leyna
authors: Kagoma S
authors: KS
authors: Mnyika
authors: Akthar
authors: A
authors: Hussain
authors: Knut-Inge
authors: KI
authors: Klepp
mesh_terms: D000293:Adolescent; D000328:Adult; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology; D015497:HIV-1; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D021841:Safe Sex; D012725:Sexual Behavior; D013636:Tanzania / Q000453:epidemiology