The causal effect of education on HIV stigma in Uganda: Evidence from a natural experiment.
The causal effect of education on HIV stigma in Uganda: Evidence from a natural experiment.
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教育对乌干达艾滋病毒耻辱的因果影响：来自自然实验的证据。
DOI：
10.1016/j.socscimed.2015.08.009
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Venkataramani,AtheendarS
中科院分区：
文献类型：
--
作者：
Tsai,AlexanderC;Venkataramani,AtheendarS
艾滋病毒在撒哈拉以南非洲地区受到高度歧视。这是一个重要的公共卫生问题，因为对艾滋病毒的污名化有许多不利影响，有可能破坏控制艾滋病毒流行的努力。目的1997年乌干达普及初等教育政策的实施为我们提供了一个自然实验来检验教育与艾滋病毒耻辱有因果关系的假设。方法为了进行这项分析，我们汇集了2011年乌干达人口与健康调查和2011年乌干达艾滋病指标调查中公开提供的基于人口的数据。主要结果感兴趣的是对艾滋病毒感染者的消极态度，使用四个问题引出预期的耻辱和社会距离。结果标准最小二乘估计表明，受教育年限与艾滋病毒污名之间存在统计学上显著的负相关（p < 0.001，统计范围为4.9至14.7）。然后，我们使用自然实验设计，利用出生队列接受普及初等教育的差异作为工具变量。政策改变时年龄<13岁的参与者比年龄≥13岁的参与者多受1.36年教育。调整了中断前后的线性年龄趋势，两阶段最小二乘估计表明，教育对艾滋病毒耻辱没有统计学上显著的因果影响（p值范围为0.21至0.69）。四个估计的回归系数中有三个是正的，在所有情况下，较低的置信限令人信服地排除了大的负效应大小的可能性。这些工具变量估计有一个因果解释，并没有被几个稳健性检查推翻。我们得出的结论是，对于乌干达的年轻人来说，在普遍小学干预的推动下，在正规学校系统中接受额外教育的年数并没有对减少对艾滋病毒感染者的负面态度产生因果影响。
RationaleHIV is highly stigmatized in sub-Saharan Africa. This is an important public health problem because HIV stigma has many adverse effects that threaten to undermine efforts to control the HIV epidemic.ObjectiveThe implementation of a universal primary education policy in Uganda in 1997 provided us with a natural experiment to test the hypothesis that education is causally related to HIV stigma.MethodsFor this analysis, we pooled publicly available, population-based data from the 2011 Uganda Demographic and Health Survey and the 2011 Uganda AIDS Indicator Survey. The primary outcomes of interest were negative attitudes toward persons with HIV, elicited using four questions about anticipated stigma and social distance.ResultsStandard least squares estimates suggested a statistically significant, negative association between years of schooling and HIV stigma (eachP< 0.001, witht-statistics ranging from 4.9 to 14.7). We then used a natural experiment design, exploiting differences in birth cohort exposure to universal primary education as an instrumental variable. Participants who were <13 years old at the time of the policy change had 1.36 additional years of schooling compared to those who were ≥13 years old. Adjusting for linear age trends before and after the discontinuity, two-stage least squares estimates suggested no statistically significant causal effect of education on HIV stigma (P-values ranged from 0.21 to 0.69). Three of the four estimated regression coefficients were positive, and in all cases the lower confidence limits convincingly excluded the possibility of large negative effect sizes. These instrumental variables estimates have a causal interpretation and were not overturned by several robustness checks.ConclusionWe conclude that, for young adults in Uganda, additional years of education in the formal schooling system driven by a universal primary school intervention have not had a causal effect on reducing negative attitudes toward persons with HIV.