London School of Hygiene & Tropical Medicine

A study published today in the Journal of Epidemiology and Community Health suggests that secondary school attendance is linked to lower risk of HIV infection among young people in rural South Africa.

The study, a collaboration between the School of Public Health, University of the Witwatersrand and the London School of Hygiene and Tropical Medicine (LSHTM), examined sexual behaviour and HIV prevalence among 916 young men and 1003 young women aged 14 to 25 in rural South Africa. The researchers wanted to know whether youth who remain in school are at higher or lower risk of HIV infection, compared to similar, out-of-school peers.

The team, led by Dr James Hargreaves of the LSHTM's Infectious Disease Epidemiology Unit, found that among both sexes, those in school reported fewer sexual partners, compared to their out-of-school peers. For female students, this partner reduction was accompanied by other protective behaviours such as greater condom use, less frequent sex, and partners who were closer to their own age. Strikingly, male students were much less likely to be HIV positive than their out-of-school peers.

In light of recent setbacks, such as the disappointing closure of the Merck HIV vaccine trial, such findings suggest that we should not overlook potential "social vaccines" which, in addition to biomedical interventions, can play a critical role in HIV prevention. Dr Hargreaves comments: "Our study suggests that, in South Africa, being in school can shape young people's social networks, leading to less high-risk sexual behaviour and, therefore, lower rates of HIV infection. We also recently conducted a review of 36 studies across sub-Saharan Africa which came to the same conclusions - that across a number of countries, those with higher education may now be at lower risk of HIV infection, reversing previous trends. We need to accelerate efforts to increase access to education, including secondary education, if we are going to make an impact on this epidemic. It's encouraging that African governments, the G8, the World Bank, and others have committed to these goals - now there is even more evidence why we should do it. "

• The association between school attendance, HIV infection and sexual behaviour among young people in rural South Africa. James R Hargreaves, Linda A Morison, Julia C Kim, Christopher P Bonell, Godfrey Phetla, John D H Porter, Charlotte Watts, Joanna Busza, Paul M Pronyk. London School of Hygiene & Tropical Medicine. J Epidemiol Community Health 2008; 62: 113-119. http://jech.bmj.com/cgi/content/full/62/2/113?rss=1
• Systematic review exploring time-trends in the association between educational attainment and risk of HIV infection in sub-Saharan Africa. James R Hargreaves, Christopher P Bonell, Tania Boler, Delia Bocca, Isolde Birdthistle, Adam Fletcher, Paul M Pronyk, Judith R Glynn. London School of Hygiene & Tropical Medicine. AIDS 2008, 22:403-414.