Education attainment and the risk of HIV-1 infections in rural Kilimanjaro Region of Tanzania, 1991-2005: a reversed association

Sex Transm Dis. 2007 Dec;34(12):947-53. doi: 10.1097/olq.0b013e31813e0c15.


Objective: Previous studies found educated individuals to have higher risk of human immunodeficiency virus (HIV)-1 infection in Africa. A reverse in this association was predicted. We investigated the change in this association from 1991 to 2005 in a rural population in Tanzania.

Study design: Two cross-sectional surveys were conducted in 1991(N = 1,152, response rate 76.4%) and 2005 (N = 1,528, 73.0%). Consenting individuals aged 15 to 44 years living in Oria village were interviewed and gave blood for HIV-1 testing.

Results: Primary [adjusted odds ratio (AOR), 2.7; 95% confidence interval (CI): 1.3-20.0] and secondary/higher education (AOR, 4.5; 95% CI: 1.4-24.9) were associated with increased risk of HIV-1 infection in 1991. A reversed association was observed in 2005 where reduced odds of infection were associated with primary (AOR, 0.5; 95% CI: 0.2-0.8) and secondary/higher education (AOR, 0.4; 95% CI: 0.3-0.9). This was most pronounced among educated men. Corresponding reduction in risk behaviors were observed. Increased odds of reporting ever use of condom (AOR, 2.8; 95% CI: 1.1-7.3) and 70% reduction in reporting >or=2 sexual partners in the past year was observed among educated women. Educated men reported 60% reduction in the odds of reporting >or=2 sexual partners in the past month preceding the last survey.

Conclusions: A reversed association between education attainment and HIV-1 infection was observed in this population between 1991 and 2005. Education seems to have an empowering role in women. Decreased risk among educated men may have an impact on HIV-1 transmission. Improving education sector in rural areas might be instrumental in the fight against the HIV epidemic.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Educational Status*
  • Female
  • HIV Infections / epidemiology*
  • HIV Infections / virology
  • HIV-1*
  • Humans
  • Male
  • Prevalence
  • Risk Factors
  • Rural Population*
  • Safe Sex
  • Sexual Behavior
  • Tanzania / epidemiology