Association Between Educational Attainment And Sexual Behaviors Related To Hiv/Aids In Two Sub-Saharan African Countries

Abstract

Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS) is a public health problem. Worldwide, about 24 million people have died from AIDS and 33.3 million are infected with HIV. Africa accounts for 68% of new infections and 72% of global AIDS mortality. Epidemiological studies are needed to investigate the social determinants of HIV/AIDS-related sexual behaviors in Africa. This study investigated the association between educational attainment (EA) and condom use at high-risk sexual intercourse and multiple sexual partnerships in two African countries. It also determined whether HIV/AIDS knowledge mediated the association between EA and condom use and single sexual partnerships. Secondary but separate country analyses of nationally-representative cross-sectional Demographic and Health Surveys (DHS) in Swaziland (SDHS 2006-07) and Zimbabwe (ZDHS 2005-06) were conducted. The dichotomous dependent variables were condom use at last high-risk sexual intercourse and single sexual partnerships. The independent variable was EA categorized as no education, incomplete primary, complete primary, incomplete secondary, complete secondary, and higher. Multivariate logistic regression models were used to analyze the effects of EA and other determinants on condom use and single sexual partnerships. In Swaziland, 42% used condoms at last high-risk sexual intercourse while 68% had one sexual partnership. After adjusting for demographic characteristics and HIV/AIDS knowledge, attitudes and beliefs, condom use was positively associated with all EA levels beyond primary education: incomplete secondary education; complete secondary education, and higher education. Condom use was not associated with HIV/AIDS knowledge, but single sexual partnership was associated with four correct HIV/AIDS knowledge. In Zimbabwe, 16% used condom at last high-risk sexual intercourse, and 86% engaged in single sexual partnerships. Condom use was associated with EA but for only those who completed secondary education. Condom use was associated with one, three and four correct HIV/AIDS knowledge levels, and single sexual partnership was associated with all but one correct HIV/AIDS knowledge levels. In both countries, single sexual partnership was not associated with EA and HIV/AIDS knowledge had no multiplicative effect on the observed association between condom use and sexual monogamy. Findings from this study will be useful in the design and implementation of multi-sectoral HIV/AIDS interventions and policies.