Mmbaga Elia J, Leyna Germana H, Mnyika Kagoma S, Hussain Akthar, Klepp Knut-Inge
Department of Epidemiology and Biostatistics, Muhimbili University of Health Sciences, Tanzania.
Sex Transm Dis. 2007 Dec;34(12):947-53. doi: 10.1097/olq.0b013e31813e0c15.
Previous studies found educated individuals to have higher risk of human immunodeficiency virus (HIV)-1 infection in Africa. A reverse in this association was predicted. We investigated the change in this association from 1991 to 2005 in a rural population in Tanzania.
Two cross-sectional surveys were conducted in 1991(N = 1,152, response rate 76.4%) and 2005 (N = 1,528, 73.0%). Consenting individuals aged 15 to 44 years living in Oria village were interviewed and gave blood for HIV-1 testing.
Primary [adjusted odds ratio (AOR), 2.7; 95% confidence interval (CI): 1.3-20.0] and secondary/higher education (AOR, 4.5; 95% CI: 1.4-24.9) were associated with increased risk of HIV-1 infection in 1991. A reversed association was observed in 2005 where reduced odds of infection were associated with primary (AOR, 0.5; 95% CI: 0.2-0.8) and secondary/higher education (AOR, 0.4; 95% CI: 0.3-0.9). This was most pronounced among educated men. Corresponding reduction in risk behaviors were observed. Increased odds of reporting ever use of condom (AOR, 2.8; 95% CI: 1.1-7.3) and 70% reduction in reporting >or=2 sexual partners in the past year was observed among educated women. Educated men reported 60% reduction in the odds of reporting >or=2 sexual partners in the past month preceding the last survey.
A reversed association between education attainment and HIV-1 infection was observed in this population between 1991 and 2005. Education seems to have an empowering role in women. Decreased risk among educated men may have an impact on HIV-1 transmission. Improving education sector in rural areas might be instrumental in the fight against the HIV epidemic.
先前的研究发现，在非洲，受过教育的人感染人类免疫缺陷病毒1型（HIV-1）的风险更高。预计这种关联会出现逆转。我们调查了1991年至2005年坦桑尼亚农村人口中这种关联的变化情况。
1991年（N = 1152，应答率76.4%）和2005年（N = 1528，73.0%）进行了两次横断面调查。对居住在奥里亚村的15至44岁的同意参与调查者进行访谈，并采集血液进行HIV-1检测。
1991年，小学教育程度（校正优势比[AOR]，2.7；95%置信区间[CI]：1.3 - 20.0）和中学/高等教育程度（AOR，4.5；95% CI：1.4 - 24.9）与HIV-1感染风险增加相关。2005年观察到一种相反的关联，即小学教育程度（AOR，0.5；95% CI：0.2 - 0.8）和中学/高等教育程度（AOR，0.4；95% CI：0.3 - 0.9）与感染几率降低相关。这在受过教育的男性中最为明显。观察到风险行为相应减少。受过教育的女性报告曾使用避孕套的几率增加（AOR，2.8；95% CI：1.1 - 7.3），且过去一年报告有≥2个性伴侣的比例降低了70%。受过教育的男性报告，在上次调查前一个月内有≥2个性伴侣的几率降低了60%。
1991年至2005年期间，在这一人群中观察到教育程度与HIV-1感染之间的关联出现了逆转。教育似乎对女性具有赋权作用。受过教育的男性感染风险降低可能会对HIV-1传播产生影响。改善农村地区的教育部门可能有助于抗击艾滋病疫情。
