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The effect of educational attainment and other factors on HIV risk in South African women: results from antenatal surveillance, 20002005

Johnson, Leigh Fa; Dorrington, Rob Ea; Bradshaw, Debbieb; Plessis, Hendrika duc; Makubalo, Lindiwed

doi: 10.1097/QAD.0b013e32832d407e
Epidemiology and social

Objectives: To assess the effect of educational attainment and other factors on the risk of HIV in pregnant South African women.

Design: Repeated cross-sectional surveys.

Methods: Pregnant women attending public antenatal clinics were tested for HIV annually between 2000 and 2005, and provided demographic information. Logistic regression models were applied separately to the data collected in each year, to identify factors associated with HIV infection. Data from all years were combined in a logistic regression model that tested for trends in HIV prevalence.

Results: Amongst women aged 15–24 years, HIV risk in those who had completed secondary education was significantly lower than in those who had only primary education, in all years except 2000. HIV risk increased by 8% per annum (odds ratio 1.08, 95% confidence interval 1.04–1.12) in young women with no secondary education but did not increase in young women with secondary education. In women aged 25–49 years, HIV risk increased over the 2000–2005 period, at all levels of educational attainment, and did not differ between women with completed secondary education and women with only primary education.

Conclusion: Together with other evidence, this study suggests that higher educational attainment did not protect against HIV in the early stages of the South African HIV/AIDS epidemic. In recent years, the risk of HIV infection in young South African women with completed secondary education has reduced significantly relative to that in young women with primary education, suggesting that HIV prevention strategies may have been more effective in more educated women.

aCentre for Actuarial Research, University of Cape Town, South Africa

bBurden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa

cStatistics South Africa

dDepartment of Health, Pretoria, South Africa.

Received 13 November, 2008

Revised 15 April, 2009

Accepted 22 April, 2009

Correspondence to Dr Leigh Johnson, Centre for Actuarial Research, University of Cape Town, Private Bag, Rondebosch 7701, South Africa. Tel: +27 21 650 5761; fax: +27 21 650 5937; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.