Institutional members access full text with Ovid®

Share this article on:

Effect of Schooling on Age-Disparate Relationships and Number of Sexual Partners Among Young Women in Rural South Africa Enrolled in HPTN 068

Stoner, Marie C. D. MPH*; Edwards, Jessie K. MSPH, PhD*; Miller, William C. MD, PhD*,†; Aiello, Allison E. MS, PhD*; Halpern, Carolyn T. MA, PhD; Julien, Aimée MPH*,§; Selin, Amanda MHS*; Hughes, James P. PhD‖,¶; Wang, Jing MS, MA; Gomez-Olive, Francesc Xavier MSc, MD, PhD§,#; Wagner, Ryan G. MSc, PhD§; MacPhail, Catherine PhD§,**,††; Kahn, Kathleen MD, MPH, PhD§,#,‡‡; Pettifor, Audrey MPH, PhD*,§

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 15, 2017 - Volume 76 - Issue 5 - p e107–e114
doi: 10.1097/QAI.0000000000001544
Prevention Research

Background: Attending school may have a strong preventative association with sexually transmitted infections among young women, but the mechanism for this relationship is unknown. One hypothesis is that students who attend school practice safer sex with fewer partners, establishing safer sexual networks that make them less exposed to infection.

Setting: We used longitudinal data from a randomized controlled trial of young women aged 13–20 years in the Bushbuckridge district, South Africa, to determine whether the percentage of school days attended, school dropout, and grade repetition are associated with having a partner 5 or more years older (age–disparate) and with the number of sexual partners in the previous 12 months.

Methods: Risks of having an age-disparate relationship and number of sexual partners were compared using inverse probability of exposure weighted Poisson regression models. Generalized estimating equations were used to account for repeated measures.

Results: Young women who attended fewer school days (<80%) and who dropped out of school were more likely to have an age–disparate relationship (risk difference 9.9%, 95% confidence interval [CI]: 3.9% to 16.0%; risk difference (%) dropout 17.2%, 95% CI: 5.4% to 29.0%) and those who dropped out reported having fewer partners (count difference dropout 0.343, 95% CI: 0.192 to 0.495). Grade repetition was not associated with either behavior.

Conclusion: Young women who less frequently attend school or who drop out are more likely to have an age-disparate relationship. Young women who drop out have overall more partners. These behaviors may increase the risk of exposure to HIV infection in young women out of school.

Supplemental Digital Content is Available in the Text.

*Department of Epidemiology, University of North Carolina, Chapel Hill, NC;

Division of Epidemiology, The Ohio State University, Columbus, OH;

Department of Maternal and Child Health, University of North Carolina, Chapel Hill, NC;

§Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;

Department of Biostatistics, University of Washington, Seattle, WA;

Fred Hutchinson Cancer Research Center, Seattle, WA;

#INDEPTH Network, Accra, Ghana;

**Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa;

††School of Health and Society, University of Wollongong, NSW, Australia; and

‡‡Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

Correspondence to: Marie C. D. Stoner, MPH, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7435 (e-mail:

Supported by grant T32 5T32AI007001 from National Institutes of Health. Funding support for the HPTN was provided by the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Mental Health (NIMH), and the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH; award numbers UM1AI068619) (HPTN Leadership and Operations Center), UM1AI068617 (HPTN Statistical and Data Management Center), and UM1AI068613 (HPTN Laboratory Center). The study was also funded under R01MH087118 and R24 HD050924 to the Carolina Population Center. Additional funding was provided by the Division of Intramural Research, NIAID, and NIH. The Agincourt Health and Socio-Demographic Surveillance System is supported by the School of Public Health University of the Witwatersrand and Medical Research Council, South Africa, and the UK Wellcome Trust (grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; and 085477/B/08/Z). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Presented at International AIDS Society (IAS) conference 2017; July 23–26, 2017; Paris, France.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

Received March 27, 2017

Accepted August 30, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.