title: Rising School Enrollment and Declining HIV and Pregnancy Risk Among Adolescents in Rakai District, Uganda, 1994-2013.
abstract: BACKGROUND
  Poverty, family stability, and social policies influence the ability of adolescents to attend school. Likewise, being enrolled in school may shape an adolescent's risk for HIV and pregnancy. We identified trends in school enrollment, factors predicting school enrollment (antecedents), and health risks associated with staying in or leaving school (consequences).
  
  
  METHODS
  Data from the Rakai Community Cohort Study (RCCS) were examined for adolescents 15-19 years (n=21,735 person-rounds) from 1994 to 2013. Trends, antecedents, and consequences were assessed using logistic and linear regression with robust variance estimation. Qualitative data were used to explore school leaving among HIV+ and HIV- youth (15-24 years).
  
  
  RESULTS
  School enrollment and socioeconomic status (SES) rose steadily from 1994 to 2013 among adolescents; orphanhood declined after availability of antiretroviral therapy. Antecedent factors associated with school enrollment included age, SES, orphanhood, marriage, family size, and the percent of family members <20 years. In qualitative interviews, youth reported lack of money, death of parents, and pregnancy as primary reasons for school dropout. Among adolescents, consequences associated with school enrollment included lower HIV prevalence, prevalence of sexual experience, and rates of alcohol use and increases in consistent condom use. Young women in school were more likely to report use of modern contraception and never being pregnant. Young men in school reported fewer recent sexual partners and lower rates of sexual concurrency.
  
  
  CONCLUSIONS
  Rising SES and declining orphanhood were associated with rising school enrollment in Rakai. Increasing school enrollment was associated with declining risk for HIV and pregnancy.
authors.affiliation: Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue B-2, New York, NY 10032.
authors.forename: John
authors.initials: J
authors.lastname: Santelli
authors.affiliation: Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue B-2, New York, NY 10032 sm2892@columbia.edu.
authors.forename: Sanyukta
authors.initials: S
authors.lastname: Mathur
authors.affiliation: Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168 Street, 6 Floor, New York, NY 10032 xs2148@columbia.edu.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Song
authors.affiliation: Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168 Street, 6 Floor, New York, NY 10032 th2455@columbia.edu.
authors.forename: Tzu Jung
authors.initials: TJ
authors.lastname: Huang
authors.affiliation: Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168 Street, 6 Floor, New York, NY 10032 yw2148@columbia.edu.
authors.forename: Ying
authors.initials: Y
authors.lastname: Wei
authors.affiliation: Rakai Health Sciences Program, Uganda Virus Research Institute, Nakiwogo Road, P.O. Box 49, Entebbe, Uganda tlutalo@rhsp.org.
authors.forename: Tom
authors.initials: T
authors.lastname: Lutalo
authors.affiliation: Rakai Health Sciences Program, Uganda Virus Research Institute, Nakiwogo Road, P.O. Box 49, Entebbe, Uganda fnalugoda@rhsp.org.
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St #5041, Baltimore, MD 21205 rgray@jhsph.edu.
authors.forename: Ron H
authors.initials: RH
authors.lastname: Gray
authors.affiliation: Rakai Health Sciences Program, Uganda Virus Research Institute, Nakiwogo Road, P.O. Box 49, Entebbe, Uganda dserwada@infocom.co.ug.
authors.forename: David M
authors.initials: DM
authors.lastname: Serwadda
keywords: Education; Gender; HIV risk; Orphanhood; Sibship; Socioeconomic status