Investing In Secondary Schooling To Reduce HIV Risk

项目摘要 中等教育被誉为预防艾滋病毒感染的“社会疫苗”，尤其是对年轻人而言。 在撒哈拉以南非洲继续经历艾滋病毒高发病率的妇女。教育可能会提供艾滋病毒 信息、健康素养和经济赋权，降低交易性行为的风险。然而直到最近 关于教育和艾滋病毒风险之间关系的证据仅限于相关研究，容易患上 令人困惑。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降低艾滋病毒感染率联系起来的第一个因果证据。 1996年，博茨瓦纳改变了中学年级结构，将高中10年级改为10年级。 到初中。因为有更多的初中学校，这项政策急剧减少 距离最近的10年级教室，导致#年的总受教育年数增加了0.8年 受影响的出生队列。利用教育中的这种外生变异，我们发现出生队列进入 在1996年或以后的中学，在以后接触艾滋病毒时，感染艾滋病毒的风险显著降低。 以人口为基础的生物标志物调查。改革带来的额外一年的就学时间减少了 艾滋病毒10年累计发病率从25%上升到18%。我们的发现被PEPFAR/美国国际开发署引用 拨款1亿多美元支持中学扩建以预防艾滋病毒，作为梦想的一部分 倡议和最近宣布的中等教育扩展促进发展(SEED)倡议。 在此基础上，这份R03《现有数据集的二次分析》提案将决定 近端行为(目标1)和行为改变的远端机制(目标2)解释 博茨瓦纳学校改革对减少艾滋病毒感染的影响。为落实建议的研究，我们 我汇编了我们原始研究中无法获得的丰富的次要数据集，包括所有四个 博茨瓦纳艾滋病影响调查的浪潮、四次博茨瓦纳人口普查和两次博茨瓦纳劳动力 调查，提供近端和远端机制的测量。我们将使用 与我们在最初研究中实施的计量经济学方法相同。我们的假设是次要的 学校教育改变了生育率和劳动力市场偏好，导致经济独立和较低的艾滋病毒风险。 迫切需要了解中等教育降低 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。

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.