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.


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