Investing In Secondary Schooling To Reduce HIV Risk

投资中学教育以降低艾滋病毒风险

• 批准号: 10004115
• 负责人: Jacob Bor
• 金额: $ 8.25万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10004115
• 关键词: AIDS prevention; Access to Information; Acquired Immunodeficiency Syndrome; Address; Adolescence; Adolescent HIV risk; Affect; Africa South of the Sahara; Age; Attitude; Behavior; Behavioral; Behavioral Mechanisms; Biological Markers; Birth; Botswana; Censuses; Correlation Studies; Data; Data Collection; Data Set; Dependence; Development; Distal; Econometric Models; Economics; Education; Educational Background; Exposure to; Female Adolescents; Fertility; Foundations; Future; Gender; Goals; HIV; HIV Infections; HIV risk; Health; Health behavior; Household; Human immunodeficiency virus test; Incidence; Income; Inequality; Intervention; Investments; Knowledge; Labor Forces; Lead; Length; Life; Life Cycle Stages; Light; Link; Marriage; Measures; Natural experiment; Outcome; Paper; Pathway interactions; Policies; Population; Prevention strategy; Production; Public Health; Randomized; Reproductive Health; Research; Risk; Risk Behaviors; Risk Reduction; Schools; Secondary Schools; Secondary to; Sex Behavior; Sexual Abstinence; Sexual Health; Sexual Partners; Structure; Surveys; Testing; USAID; Vaccines; Variant; Woman; Work; base; behavior change; child bearing; cohort; condoms; critical period; delay sexual debut; design; econometrics; effective intervention; empowerment; experience; global health; health economics; health literacy; human capital; infection rate; infection risk; innovation; labor force participation; population based; population survey; preference; secondary analysis; sex; sexual risk taking; skills; social; statistics; young woman

Project Summary Secondary education has been hailed as a “social vaccine” against HIV acquisition, particularly for young women who continue to experience high HIV incidence in sub-Saharan Africa. Education may provide HIV information, health literacy, and economic empowerment, reducing risks of transactional sex. Yet until recently evidence on the relationship between education and HIV risk was limited to correlational studies, vulnerable to confounding. In a recent paper in Lancet Global Health, we evaluated a natural experiment in Botswana, generating some of the first causal evidence linking education levels to reduced HIV infection rates. In 1996, Botswana changed the grade structure of secondary school, shifting grade 10 from senior secondary to junior secondary. Because there are many more junior secondary schools, this policy sharply reduced distance to the nearest grade 10 classroom and resulted in a 0.8-year increase in total years of schooling for affected birth cohorts. Exploiting this exogenous variation in education, we found that birth cohorts entering secondary school in or after 1996 had significantly lower risk of HIV infection when contacted in later population-based biomarker surveys. One additional year of schooling resulting from the reform reduced the 10-year cumulative incidence of HIV from 25% to 18%. Our findings were cited by PEPFAR/USAID in allocating over $100M to support secondary school expansion for HIV prevention, as part of the DREAMS initiative and the recently announced Secondary Education Expansion for Development (SEED) initiative. Building on this foundation, this R03 proposal for “Secondary Analyses of Existing Datasets” will determine the proximate behaviors (Aim 1) and the distal mechanisms for behavior change (Aim 2) that explain the impact of Botswana’s schooling reform on reduced HIV acquisition. To implement the proposed research, we have compiled a rich array of secondary datasets not available to us in our original study, including all four waves of the Botswana AIDS Impact Survey, four Botswana Censuses, and two Botswana Labor Force Surveys, which provide measures of proximate and distal mechanisms. We will analyze the data using the same econometric approach that we implemented in our original study. Our hypothesis is that secondary schooling shifted fertility and labor market preferences, leading to economic independence and lower HIV risk. There is a critical need to understand the mechanisms through which secondary education reduces HIV risk. The proposed research will shed light on whether the lessons from Botswana can be generalized to other settings and what mechanisms should be targeted by future education reforms for maximum HIV impact.

项目摘要 中等教育被誉为预防艾滋病毒感染的“社会疫苗”，特别是对年轻人来说。 在撒哈拉以南非洲，妇女艾滋病毒感染率仍然很高。教育可以提供艾滋病毒 信息、卫生知识普及和经济赋权，减少性交易的风险。然而直到最近 关于教育与艾滋病毒风险之间关系的证据仅限于相关性研究， 真让人困惑在最近发表在《柳叶刀全球健康》上的一篇论文中，我们评估了博茨瓦纳的一项自然实验， 产生了一些将教育水平与艾滋病毒感染率降低联系起来的第一批因果证据。 1996年，博茨瓦纳改变了中学的年级结构，将高中改为10年级 升读初中。因为初中多了，这个政策锐减 到最近的十年级教室的距离缩短， 受影响的出生队列。利用教育中的这种外源性变化，我们发现， 在1996年或以后的中学， 基于人群的生物标志物调查。由于改革而增加的一年学校教育， 10-年累计艾滋病发病率由25%降至18%。我们的研究结果被PEPFAR/USAID引用， 拨款超过1亿美元，支持中学扩大艾滋病毒预防，作为梦想的一部分 这是一项新的倡议，也是最近宣布的中等教育扩大促进发展（SEED）倡议。 在此基础上，R 03关于“现有数据集的二次分析”的提案将确定 近端行为（目标1）和远端机制的行为变化（目标2），解释了 博茨瓦纳学校改革对减少艾滋病毒感染的影响。为了实施拟议的研究，我们 我编制了一系列丰富的二级数据集，这些数据集在我们最初的研究中是不可用的，包括所有四个数据集。 博茨瓦纳艾滋病影响调查、四次博茨瓦纳人口普查和两次博茨瓦纳劳动力普查 调查，提供近端和远端机制的测量。我们将使用 与我们最初研究中采用的计量经济学方法相同。我们的假设是， 学校教育改变了生育率和劳动力市场偏好，导致经济独立和降低艾滋病毒风险。 迫切需要了解中等教育减少 艾滋病毒风险。拟议的研究将阐明博茨瓦纳的经验教训是否可以推广到 其他环境以及未来的教育改革应针对哪些机制，以最大限度地发挥艾滋病毒的影响。