title: The impact of education on sexual behavior in sub-Saharan Africa: a review of the evidence.
abstract: Many studies have attempted to determine the relationship between education and HIV status. However, a complete and causal understanding of this relationship requires analysis of its mediating pathways, focusing on sexual behaviors. We developed a series of hypotheses based on the differential effect of educational attainment on three sexual behaviors. We tested our predictions in a systematic literature review including 65 articles reporting associations between three specific sexual behaviors -- sexual initiation, number of partners, and condom use -- and educational attainment or school enrollment in sub-Saharan Africa. The patterns of associations varied by behavior. The findings for condom use were particularly convergent; none of the 44 studies using educational attainment as a predictor reviewed found that more educated people were significantly less likely to use condoms. Findings for sexual initiation and number of partners were more complex. The contrast between findings for condom use on the one hand and sexual initiation and number of partners on the other supports predictions based on our theoretical framework.
authors.affiliation: Harvard Graduate School of Education, Cambridge, MA, USA. sls418@mail.harvard.edu
authors.forename: Stephanie Simmons
authors.initials: SS
authors.lastname: Zuilkowski
authors.forename: Matthew C H
authors.initials: MC
authors.lastname: Jukes
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control*; D000293:Adolescent; D017954:Africa South of the Sahara / Q000453:epidemiology; D002648:Child; D017280:Condoms / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012747:Sexual Partners; D055815:Young Adult