Multilevel Measures of Education and Pathways to Incident Herpes Simplex Virus Type 2 in Adolescent Girls and Young Women in South Africa

Marie C D Stoner; Torsten B Neilands; Kathleen Kahn; James P Hughes; F Xavier Gómez-Olivé; Rhian Twine; Stephen Tollman; Oliver Laeyendecker; Catherine MacPhail; Jennifer Ahern; Sheri A Lippman; Audrey Pettifor

doi:10.1016/j.jadohealth.2019.06.008

Multilevel Measures of Education and Pathways to Incident Herpes Simplex Virus Type 2 in Adolescent Girls and Young Women in South Africa

J Adolesc Health. 2019 Dec;65(6):723-729. doi: 10.1016/j.jadohealth.2019.06.008. Epub 2019 Sep 11.

Authors

Affiliations

¹ Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina. Electronic address: stonerm@email.unc.edu.
² Department of Medicine, University of California, San Francisco, San Francisco, California.
³ MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana; Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
⁴ Department of Biostatistics, University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington.
⁵ MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
⁶ MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁷ INDEPTH Network, Accra, Ghana.
⁸ Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland.
⁹ MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Health and Society, University of Wollongong, New South Wales, Australia; Wits Reproductive Health and HIV Research Institute, University of the Witwatersrand, Johannesburg, South Africa.
¹⁰ Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California.
¹¹ Department of Medicine, University of California, San Francisco, San Francisco, California; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹² Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina.

Abstract

Purpose: Schooling is associated with a lower risk of Herpes simplex virus type 2 (HSV-2) in adolescent girls and young women, but there is little understanding of the pathways underlying this relationship.

Methods: We used data from adolescent girls and young women in South Africa enrolled in the HIV Prevention Trials Network 068 study. We tested a structural equation model where individual household and community education measures were associated directly and indirectly with incident HSV-2 through HIV knowledge, future aspirations, age-disparate partnerships, sex in the last 12 months, and condomless sex.

Results: Community, household, and individual measures of schooling were all associated with incident HSV-2 infection through mediated pathways that increased the likelihood of having sex. Low school attendance (<80% of school days) increased the likelihood of having sex through increased age-disparate partnerships and reduced future aspirations. Fewer community years of education increased the likelihood of having sex through increased age-disparate partnerships. Parental education level was indirectly associated with HSV-2 overall, although we could not identify the individual pathways that were responsible for this association.

Conclusions: Community and individual schooling interventions may reduce the risk of HSV-2 infection by influencing the likelihood of having sex, partner age, and future aspirations.

Keywords: Adolescent girls and young women; Education; HSV-2; Mediation; Multilevel; Sexual behaviors.

MeSH terms

Adolescent
Adult
Age Factors
Educational Status*
Female
Health Education*
Herpes Genitalis* / epidemiology
Herpes Genitalis* / prevention & control
Herpesvirus 2, Human / isolation & purification*
Humans
Longitudinal Studies
Risk Factors
Schools
Sexual Partners*
South Africa / epidemiology
Young Adult

Abstract

MeSH terms

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