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Improved school attendance credited with reducing HIV infections among teenage girls in Uganda
Roger Pebody, 2015-01-14 08:00:00
The Ugandan government’s decision to abolish tuition fees for school pupils, the resulting improved participation in education and an associated decline in adolescent sexual activity are responsible for substantial declines in HIV incidence and prevalence among teenage girls in the Rakai district, John Santelli and colleagues report in the January 14 edition of AIDS.
Across Africa, over a million adolescent girls are living with HIV. Whereas HIV rates are similar between boys and girls in younger age groups (with infections largely due to mother to child transmission), prevalence among girls aged 15 to 19 tends to be considerably higher than among boys of the same age.
UNAIDS argue that infection rates could be improved by reducing gender-based violence, ensuring access to quality health services, keeping girls in school and empowering young women and girls.
The data for the current study come from the rural Rakai district in the south-west of the country – a major site of HIV-related research, treatment programmes and prevention initiatives. A longitudinal cohort study has surveyed local residents on a semi-annual basis since the late 1980s, collecting demographic, behavioural and biological data, and tracking the factors associated with HIV infection.
In 2013, an analysis from this cohort identified a number of factors that were associated with new HIV infections among girls and young women, aged 15 to 24. An important one was not attending school, with current students much less likely to acquire HIV (in multivariate analysis, odds ratio 0.22, 95% confidence interval 0.07 – 0.72).
Other factors associated with new HIV infections were having been married but now separated from the partner; having two or more sexual partners in the past year; having had symptoms of a sexually transmitted infection; and living in a trading village rather than in a more isolated rural area. Of note, self-reported condom use or concurrent relationships were not associated with differences in the risk of infection.
Last year, an innovative study from this cohort found that compared with individuals who remain HIV negative, young people who have recently acquired HIV describe sexual relationships marked by poorer communication, greater suspicion and mistrust, and larger and more transitory sexual networks. The researchers pointed to poverty and gendered power relationships as deeper causes of these problems.
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