We examined the association between education and prevalent HIV-1 infection in the Rakai district, rural Uganda based on a cross-sectional analysis of a population-based cohort. In 1990, 1397 men and 1705 women aged 13 years and older, were enrolled in 31 randomly selected communities. Strata were comprised of main road trading centres, secondary road trading villages and rural villages. Sociodemographic and behavioural data were obtained by interview and serum for HIV serostatus were obtained in the home. The analysis examines the association between sex-specific prevalent HIV infection and educational attainment, categorized as secondary, primary or none. The odds ratios (ORs) and 95% confidence intervals (95% CIs) of HIV infection were estimated, using no education as the referent group. Higher levels of education were associated with a higher HIV seroprevalence in bivariate analyses (OR 2.7 for primary and 4.1 for secondary education, relative to no education). The strength of the association was diminished but remained statistically significant after multivariate adjustment for sociodemographic and behavioural variables (adjusted OR of HIV infection 1.6 (95% CI: 1.2-2.1)) for primary education and 1.5 (95% CI: 1.0-2.2) for secondary education. Stratified multivariate analyses by place of residence indicated that the association between education and HIV prevalence was statistically significant in the rural villages, but not in the main road trading centres and intermediate trading villages. Educational attainment is a significant predictor of HIV risk in rural Uganda, in part because of risk behaviours and other characteristics among better educated individuals. Preventive interventions need to focus on better educated adults and on school-aged populations.
PIP: This is a cross-sectional analysis of a population-based cohort study conducted to examine both the associations between educational attainment and HIV-1 serostatus as well as the relationship between education and other HIV risk factors in Rakai district, Uganda. A total of 3102 respondents (1397 men and 1705 women aged 13 years and older) completed a questionnaire and provided blood samples. The samples of community clusters was stratified into three strata: trading centers on main roads, intermediate trading villages on secondary roads, and rural agricultural villages with no roads or only minor road connection. Analysis has shown a consistent association between higher level of educational attainment and HIV-1 prevalence among the residents. The strength of the association was decreased but remained statistically relevant after multivariate adjustment for sociodemographic and behavioral variables [adjusted OR for HIV infection, 1.6 (95% CI, 1.2-2.1) for primary education and 1.5 (95% CI, 1.0-2.2) for secondary education]. Stratified multivariate analyses by place of residence showed that the relationship between education and HIV prevalence was markedly higher in the rural villages compared to the other two strata. Education provides greater economic resources, which facilitate behaviors that put individuals at greater risk. Analysis of findings suggests that HIV prevention strategies should focus on the more educated individuals, particularly in rural settings and among younger women.