Systematic review exploring time trends in the association between educational attainment and risk of HIV infection in sub-Saharan Africa

Hargreaves, James; Bonell, Christopher; Boler, Tania; Boccia, Delia; Birdthistle, Isolde; Fletcher, Adam; Pronyk, Paul; Glynn, Judith R.

doi:10.1097/qad.0b013e3282f2aac3

Cited by 230 publications

(227 citation statements)

References 47 publications

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“…Educational attainment and the relationship between HIV-infection is closely correlated with income, gender, employment/ socioeconomic status, economic migration and urbanisation with related socio-economic implications. [11][12][23][24] Although some studies on the relationship between socio-economic changes and suicidal behaviour have produced divergent results, others have highlighted the impact on suicidal behaviour of both adverse socioeconomic factors as well as economic development. 2,[15][16] Contemporary research 25 has shown that low socioeconomic status increase the risk of suicidal behaviour, as does low educational levels and long term unemployment.…”

Section: Discussionmentioning

confidence: 99%

Suicidal ideation in seropositive patients seen at a South African HIV voluntary counselling and testing clinic

Govender¹,

Schlebusch²

2012

Afr. J. Psych

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Objective: Suicidal behaviour and HIV/AIDS are significant public health concerns. The aim of this study was to investigate suicidal ideation in patients who were referred to a voluntary HIV counselling and testing (VCT) clinic and who were found to be seropositive. This in order to improve suicide prevention and intervention strategies amongst such patients. Method: The sample studied consisted of volunteer adult patients referred over a three-month period to a HIV VCT clinic based at a university-affiliated general state hospital. Patients completed a questionnaire on sociodemographic data. Suicidal ideation was measured using the Beck Hopelessness Scale and the Beck Depression Inventory (BDI), at two time points (within 72 hours after notification and again at a 6 week follow-up). All patients received extensive pre-and post-test counselling. Results: HIV-test results were available for 189 (99.5%) of the original sample of 190 patients studied, with 157 (83.1%) testing positive. More females tested positive as did unemployed and single/divorced patients. The mean age for HIV-positive patients was 33.49 (SD = 9.449), and for HIV-negative patients it was 37.94 (SD = 15.238). Age was a significant factor in that for each year increase in age, the risk of testing HIV-positive decreased by 4.1%. Lower education and traditional beliefs were also significantly associated with testing HIV-positive. At 72 hours suicidal ideation was present in 17.1% (95% confidence interval 12.16% to 23.45%), and at 6 weeks in 24.1% (95% confidence interval 17.26% to 32.39%) of the seropositive patients. Their average BDI scores were 15.20 and 14.23 respectively at the two time points. Conclusion: Suicidal ideation was present in a significant number of the seropositive cohort studied and increased over a six week period among these patients. The average BDI scores at both time points imply a clinical depression. The findings also suggest an association between positive HIV-test results and certain socio-demographic variables that can act as indicators for suicidal ideation in HIV-infected persons, although this requires further research. Although the relationship between suicidal ideation and HIV-infection is complex, it is an important consideration when assessing patient suicide vulnerability at HIV VCT clinics and when implementing suicide prevention and management strategies.

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Section: Discussionmentioning

confidence: 99%

Suicidal ideation in seropositive patients seen at a South African HIV voluntary counselling and testing clinic

Govender¹,

Schlebusch²

2012

Afr. J. Psych

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“…Although there is a protective effect of education on HIV risk (Hargreaves et al, 2008; Jukes, Simmons, & Bundy, 2008; Pettifor et al, 2008; Pufall, Nyamukapa, Eaton, Campbell, et al, 2014), the exact mechanisms by which schooling decreases HIV risk are unclear. School education may decrease risk directly through delayed sexual debut, and by decreasing other sexual risk behaviours (e.g.…”

Section: Introductionmentioning

confidence: 99%

Education, substance use, and HIV risk among orphaned adolescents in Eastern Zimbabwe

Pufall

Eaton

Robertson

et al. 2017

Vulnerable Children and Youth Studies

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There is a growing interest in education as a means to reduce HIV infection in vulnerable children in sub-Saharan Africa; however, the mechanisms by which education reduces HIV infection remain uncertain. Substance use has been associated with high-risk sexual behaviour and could lie on the causal pathway between education and HIV risk. Therefore, we used multivariable regression to measure associations between: (i) orphanhood and substance use (alcohol, recreational drugs, and smoking), (ii) substance use and sexual risk behaviours, and (iii) school enrolment and substance use, in adolescents aged 15–19 years, in Eastern Zimbabwe. We found substance use to be low overall (6.4%, 3.2%, and 0.9% of males reported alcohol, drug, and cigarette use; <1% of females reported any substance use), but was more common in male maternal and double orphans than non-orphans. Substance use was positively associated with early sexual debut, number of sexual partners, and engaging in transactional sex, while school enrolment was associated with lower substance use in males. We conclude that education may reduce sexual risk behaviours and HIV infection rates among male adolescents in sub-Saharan Africa, in part, by reducing substance abuse.

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“…Eastern Africa is catching up with southern Africa, after national policies dropped user-fees at the turn of the century (figures 1 and 2). Since about 1996 Sub-Saharan Africa has witnessed a reversal of association between educational attainment and risk of HIV infection, from hazardous to protective (Michelo et al 2006, Hargreaves et al 2008a). Out-of-school youth are the main category failing to benefit from this reversal.…”

mentioning

confidence: 99%

HIV among out-of-school youth in Eastern and Southern Africa: a review

et al. 2011

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Systematic review exploring time trends in the association between educational attainment and risk of HIV infection in sub-Saharan Africa

Abstract: HIV infections appear to be shifting towards higher prevalence among the least educated in sub-Saharan Africa, reversing previous patterns. Policy responses that ensure HIV-prevention measures reach all strata of society and increase education levels are urgently needed.

Cited by 230 publications

References 47 publications

Suicidal ideation in seropositive patients seen at a South African HIV voluntary counselling and testing clinic

Suicidal ideation in seropositive patients seen at a South African HIV voluntary counselling and testing clinic

Education, substance use, and HIV risk among orphaned adolescents in Eastern Zimbabwe

HIV among out-of-school youth in Eastern and Southern Africa: a review

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