Effect of schooling on age-disparate relationships and number of sexual partners among young women in rural South Africa enrolled in HPTN 068

Marie Stoner, University of North Carolina
Jessie Edwards, University of North Carolina
William Miller, University of North Carolina
Allison Aiello, University of North Carolina
Carolyn Halpern, University of North Carolina
Aimee Julien, University of The Witwatersrand
Amanda Selin, University of North Carolina
James Hughes, University of Washington
Jing Wang, Fred Hutchinson Cancer Research Center
F Gomez-Olive, University of The Witwatersrand
Ryan Wagner, University of The Witwatersrand
Catherine L. Mac Phail, University of Wollongong
Kathleen Kahn, University of The Witwatersrand
Audrey Pettifor, University of North Carolina

Stoner, M. C. D., Edwards, J. K., Miller, W. C., Aiello, A. E., Halpern, C. T., Julien, A., Selin, A., Hughes, J., Wang, J. P., Gomez-Olive, F. X., Wagner, R. G., MacPhail, C., Kahn, K. & Pettifor, A. (2017). Effect of schooling on age-disparate relationships and number of sexual partners among young women in rural South Africa enrolled in HPTN 068. JAIDS: Journal of Acquired Immune Deficiency Syndromes, 76 (5), e107-e114.

Abstract

Background: 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. Setting: We used longitudinal data from a randomized controlled trial of young women age 13-20 in the Bushbuckridge district, South Africa, to determine if the percentage of school days attended, school dropout and grade repetition are associated with having a partner five or more years older (age-disparate) and with the number of sexual partners in the previous 12 months. Methods: Risks of having an age-disparate relationship and counts of sex partners were compared using inverse probability of exposure weighted Poisson regression models. Generalized estimating equations were used to account for repeated measures. Results: 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 (RD) 9.9%, 95% CI 3.9%,16.0%; RD (%) dropout 17.2%, 95% CI: 5.4%,29.0%) and those who dropped out reported having fewer partners (count difference (CD) dropout 0.343, 95% CI: 0.192, 0.495). Grade repetition was not associated with either behavior. Conclusion: 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 more partners overall. These behaviors may increase risk of exposure to HIV infection in young women out of school.