Jukes Matthew, Simmons Stephanie, Bundy Donald
Graduate School of Education, Harvard University, Cambridge, Massachusetts 02138, USA.
AIDS. 2008 Dec;22 Suppl 4:S41-56. doi: 10.1097/01.aids.0000341776.71253.04.
Education has a potentially important role to play in tackling the spread of HIV, but is there evidence that this potential is realized? This analysis combines the results of previous literature reviews and updates them with the findings of recent randomized controlled trials and a discussion of possible mechanisms for the effect of schooling on vulnerability to HIV infection. There is a growing body of evidence that keeping girls in school reduces their risk of contracting HIV. The relationship between educational attainment and HIV has changed over time, with educational attainment now more likely to be associated with a lower risk of HIV infection than earlier in the epidemic. Educational attainment cannot, however, be isolated from other socioeconomic factors as the cause of HIV risk reduction. The findings of this analysis suggest that the equitable expansion of primary and secondary schooling for girls in southern Africa will help reduce their vulnerability to HIV. Evidence of ineffective HIV prevention education in schools underlines the need for careful evidence-based programme design. Despite the challenges, recent provisional evidence suggests that highly targeted programmes promoting realistic options for young adults may lead to safer sexual behaviour. Targeted education programmes have also been successful in changing students' attitudes to people living with HIV and AIDS, which is associated with testing and treatment decisions. This reduction in stigma may be crucial in encouraging the uptake of voluntary counselling and testing, a central strategy in the control of the epidemic. Expansions of carefully designed and evaluated school-based HIV prevention programmes can help to reduce stigma and have the potential to promote safe sexual behaviour.
教育在应对艾滋病毒传播方面可能发挥重要作用，但有没有证据表明这种潜力得到了实现呢？本分析综合了以往文献综述的结果，并根据近期随机对照试验的结果以及对学校教育影响艾滋病毒感染易感性的可能机制的讨论对其进行了更新。越来越多的证据表明，让女孩继续上学可降低她们感染艾滋病毒的风险。教育程度与艾滋病毒之间的关系随时间发生了变化，如今与疫情早期相比，教育程度更有可能与较低的艾滋病毒感染风险相关联。然而，教育程度不能作为降低艾滋病毒风险的原因而与其他社会经济因素隔离开来。该分析结果表明，在南部非洲公平扩大女童的中小学教育将有助于降低她们感染艾滋病毒的易感性。学校中无效的艾滋病毒预防教育的证据凸显了基于证据进行精心的项目设计的必要性。尽管存在挑战，但近期的初步证据表明，针对年轻人推广切实可行选择的高度针对性项目可能会带来更安全的性行为。针对性教育项目在改变学生对艾滋病毒感染者和艾滋病患者的态度方面也取得了成功，这与检测和治疗决策相关。这种耻辱感的减轻对于鼓励采用自愿咨询和检测（控制疫情的一项核心战略）可能至关重要。精心设计和评估的以学校为基础的艾滋病毒预防项目的扩展有助于减少耻辱感，并有可能促进安全性行为。
