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J Acquir Immune Defic Syndr. 2017 Dec 15;76(5):e107-e114. doi: 10.1097/QAI.0000000000001544.

Effect of Schooling on Age-Disparate Relationships and Number of Sexual Partners Among Young Women in Rural South Africa Enrolled in HPTN 068.

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*Department of Epidemiology, University of North Carolina, Chapel Hill, NC; †Division of Epidemiology, The Ohio State University, Columbus, OH; ‡Department of Maternal and Child Health, University of North Carolina, Chapel Hill, NC; §Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; ‖Department of Biostatistics, University of Washington, Seattle, WA; ¶Fred Hutchinson Cancer Research Center, Seattle, WA; #INDEPTH Network, Accra, Ghana; **Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa; ††School of Health and Society, University of Wollongong, NSW, Australia; and ‡‡Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.



Attending school may have a strong preventative association with sexually transmitted infections among young women, but the mechanism for this relationship is unknown. One hypothesis is that students who attend school practice safer sex with fewer partners, establishing safer sexual networks that make them less exposed to infection.


We used longitudinal data from a randomized controlled trial of young women aged 13-20 years in the Bushbuckridge district, South Africa, to determine whether the percentage of school days attended, school dropout, and grade repetition are associated with having a partner 5 or more years older (age-disparate) and with the number of sexual partners in the previous 12 months.


Risks of having an age-disparate relationship and number of sexual partners were compared using inverse probability of exposure weighted Poisson regression models. Generalized estimating equations were used to account for repeated measures.


Young women who attended fewer school days (<80%) and who dropped out of school were more likely to have an age-disparate relationship (risk difference 9.9%, 95% confidence interval [CI]: 3.9% to 16.0%; risk difference (%) dropout 17.2%, 95% CI: 5.4% to 29.0%) and those who dropped out reported having fewer partners (count difference dropout 0.343, 95% CI: 0.192 to 0.495). Grade repetition was not associated with either behavior.


Young women who less frequently attend school or who drop out are more likely to have an age-disparate relationship. Young women who drop out have overall more partners. These behaviors may increase the risk of exposure to HIV infection in young women out of school.

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