Education and HIV incidence among young women in KwaZulu-Natal: An association but no evidence of a causal protective effect

PLoS One. 2019 Mar 4;14(3):e0213056. doi: 10.1371/journal.pone.0213056. eCollection 2019.

Abstract

We examine the relationship between school attendance and HIV incidence among young women in South Africa. Our aim is to distinguish a causal effect from correlation. Towards this end, we apply three methods to population-based longitudinal data for 2005-2012 in KwaZulu-Natal. After establishing a negative association, we first use a method that assesses the influence of omitted variables. We then estimate models with exclusion restrictions to remove endogeneity bias, and finally we estimate models that control for unobserved factors that remain constant over time. All the three methods have strengths and weaknesses, but none of them suggests a causal effect. Thus, interventions that increase school attendance in KwaZulu-Natal would probably not mechanically reduce HIV risk for young women. Although the impact of school attendance could vary depending on context, unobserved variables are likely to be an important reason for the common finding of a negative association between school attendance and HIV incidence in the literature.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Female
  • HIV Infections / epidemiology*
  • Humans
  • Incidence
  • Longitudinal Studies
  • Models, Theoretical
  • Risk Factors
  • Schools
  • South Africa / epidemiology
  • Students*
  • Women / education*
  • Young Adult

Grants and funding

We gratefully acknowledge funding from the Swedish Research Council, The Swedish Foundation for International Cooperation in Research and Higher Education (STINT), and the National Research Foundation (NRF) - Sweden / South Africa Research Cooperation Programme for financial assistance. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.