Despite considerable attention to and investment in biomedical interventions to reduce HIV - principally microbicides and vaccines - the prevention field can point to few technological successes in recent years, aside from demonstrating the partial effectiveness of male circumcision. Because an effective technology for mitigating HIV has not yet been developed, prevention efforts have focused on behavior change - primarily partner reduction, consistent condom use, and delayed sexual initiation - via information provision and skill- building. While many trials have been conducted, and a number have been successful, at least with regard to a reduction in self-reported behaviors, rarely have any been shown to be effective in lowering the incidence of HIV infection. Given the disappointments that have confronted the HIV prevention field, a number of scientists have acknowledged the importance of investigating the ways in which broader contextual and structural factors - social, political, economic, and environmental - influence HIV risk and potentially enhance or undermine the effectiveness of interventions. The proposed research will draw on in-depth data on school quality coupled with comprehensive longitudinal data on adolescents and their HIV risk and status to elucidate the relationships between schools, educational outcomes, and HIV among young people in Malawi. Special attention will be given to the interrelationships between schooling, educational outcomes, HIV risk and status.
The specific aims of the project are to (1) measure prevalence and incidence of HIV (for females) and HSV-2 (for males and females) among a sample of Malawian adolescents;(2) to assess the direct effects of school quality on sexual behavior and infection status as well as the indirect effects that operate through educational outcomes;(3) to examine the associations between conventional educational outcomes - grade and level attained - and sexual behavior and infection status;(4) to investigate whether a more detailed set of educational outcomes - literacy and numeracy skills, reading comprehension, knowledge of reproductive biology and HIV transmission, gender attitudes, and agency (for females) - affect sexual behavior and infection status;(5) based on the research findings, to develop policy recommendations and propose designs for school-based interventions to reduce HIV risk among young people in Malawi.

Public Health Relevance

With the exception of male circumcision, biomedical interventions to reduce HIV in high prevalence countries have been disappointing. Given this lack of success, HIV prevention efforts would benefit from addressing the broader contextual and structural factors that affect sexual behavior and risk. The proposed project will draw on in-depth data on school quality coupled with comprehensive longitudinal data on adolescents and their HIV risk and status to elucidate the relationships between schools, educational outcomes, and HIV among young people in Malawi. Our research seeks to uncover those aspects of schooling that will lead to more protective behaviors and lower HIV risk among young women and men.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
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Newcomer, Susan
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Population Council
New York
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