HIV / STI
Educational Attainment and HIV Prevalence among Adolescent Girls and Young Women in Malawi: Estimating the Impact of Increased Secondary Education Completion using the Parametric G-formula Domonique Reed* Domonique Reed Katherine Keyes Jeanette Stingone Jessica Justman
In Malawi, the completion of secondary education among adolescent girls and young women (AGYW) is low due to significant financial and gender inequality barriers. As Malawi reforms its education system to expand secondary education, understanding the impact of increasing educational attainment among AGYW on prevalent HIV is crucial. We modeled the impact of increasing the proportion of AGYW who completed secondary education on prevalent HIV.
We used data from sexually active AGYW enrolled in the Malawi Population-based HIV Impact Assessment (MPHIA; 2016), a nationally representative household survey. Our outcome of interest was HIV status, and our exposure was secondary education completion. Using a logistic regression-based parametric g-formula, we modeled scenarios where 31% (observed) of AGYW completed secondary education and hypothetical increases to 50%, 75%, and 100%.
Among 2,644 AGYW studied, 69% did not complete secondary education. Those without completion showed higher rates of HIV-positive partners (2% vs. 1%), sex work (7% vs. 4%), and age-disparate relationships (33% vs. 31%). Overall, HIV prevalence was 4%, with 5% among non-completers versus 3% among completers. For the observed scenario, there was a 14% (95% CI: 0.5-1.2) decreased odds of HIV among AGYW who completed secondary education (Figure 1). For 50%, 75%, and 100% scenarios, AGYW who completed secondary education had a 16% (95% CI: 0.5-1.2), 21% (95% CI: 0.3-1.3), and 26% (0.3-1.2) decreased odds of HIV compared to AGYW who did not complete secondary education, respectively; however, all estimates were not statistically significant.
Although all associations were not statistically significant, we observed a trend that increasing the proportion of AGYW who completed secondary education reduced the overall odds of prevalent HIV. As Malawi continues discussing educational reform, research supporting increases in secondary educational attainment is paramount.
