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Increasing secondary school attendance in Botswana slashed HIV infection rates of adults, with the greatest drop among women, a study finds.
Typically, an extra year of schooling beyond primary level reduced the chance of people catching the virus by a third, according to the study in The Lancet last week (29 June).
Education is not only a highly-effective, but also a cost-efficient way of preventing HIV infection in countries where the virus is a severe burden, says Jacob Bor, an author of the study and a global health researcher at Boston University in the United States. He says policymakers too often overlook the health impacts of schooling.

“Investments in secondary schooling are a slam dunk and should go alongside biomedical interventions in any effective HIV prevention strategy.”

Jacob Bor, Boston University in the United States

“Investments in secondary schooling are a slam dunk and should go alongside biomedical interventions in any effective HIV prevention strategy,” he says.
Bor and his team focused on Botswana, a country where almost one in four of those aged between 18 and 49 are infected with the virus. They compared HIV rates in groups of people who went to school before and after a 1996 government reform that increased secondary school attendance for each person by around a year on average.
Primary education had no effect on HIV prevalence. But among those who attended an extra year of secondary school, which begins at 15, the risk of contracting the virus fell from 25·5 to 17·4 per cent, or by 8.1 percentage points.
This figure jumped to 11.6 percentage points for girls, the study found.
The gender difference could be partly due to a greater proportion of women being infected with HIV to begin with, says Bor. But he believes education also allows women to get better jobs, providing the money they need to afford protection — such as condoms — and reducing the likelihood of them getting involved in prostitution or other money-for-sex situations, which increase the risk of infection.
The Millennium Development Goals (MDGs) include targets on primary education and HIV prevention, but not secondary school education. However, the draft Sustainable Development Goals, which are to replace the MDGs, include a target to ensure universal secondary education.
Still, Karen Grépin, a health policy researcher at New York University in the United States, warns that decision makers fail to see the vital influence that education has on health. She says that progress in HIV treatment since the beginning of the century has not been matched by drops in infection rates because most programmes focus on medical strategies, such as circumcision or drug treatment.
Including education in the mix of measures to combat HIV is essential for success, she says. “This is the first convincing study showing that education can be a very powerful form of prevention for HIV,” Grépin says.


Jan-Walter De Neve and others Length of secondary schooling and risk of HIV infection in Botswana: evidence from a natural experiment (The Lancet, 29 June 2015)