Does Partner Selection Mediate the Relationship Between School Attendance and HIV/Herpes Simplex Virus-2 Among Adolescent Girls and Young Women in South Africa: An Analysis of HIV Prevention Trials Network 068 Data

Authors

Marie Stoner, University of North Carolina
Jessie Edwards, University of North Carolina
William Miller, The Ohio State University
Allison Aiello, University of North Carolina
Carolyn Halpern, University of North Carolina
Aimee Julien, University of North Carolina, University of The Witwatersrand
Katherine B. Rucinski, University of North Carolina
Amanda Selin, University of North Carolina
Rhian Twine, University of The Witwatersrand
James Hughes, University of Washington, Fred Hutchinson Cancer Research Center
Jing Wang, Fred Hutchinson Cancer Research Center
Yaw Agyei, Johns Hopkins University
Francesc Xavier Gomez-Olive, INDEPTH Network, University of The Witwatersrand
Ryan Wagner, University of The Witwatersrand, National Institutes of Health
Oliver Laeyendecker, National Institutes of Health
Catherine L. Mac Phail, University of Wollongong, University of the WitwatersrandFollow
Kathleen Kahn, University of The Witwatersrand, INDEPTH Network, Umeå University, Umeå, Sweden
Audrey Pettifor, University of The Witwatersrand, University of North Carolina

RIS ID

130780

Publication Details

Stoner, M. C. D., Edwards, J. K., Miller, W. C., Aiello, A. E., Halpern, C. T., Julien, A., Rucinski, K. B., Selin, A., Twine, R., Hughes, J. P., Wang, J., Agyei, Y., Xavier Gomez-Olive, F., Wagner, R. G., Laeyendecker, O., MacPhail, C., Kahn, K. & Pettifor, A. (2018). Does Partner Selection Mediate the Relationship Between School Attendance and HIV/Herpes Simplex Virus-2 Among Adolescent Girls and Young Women in South Africa: An Analysis of HIV Prevention Trials Network 068 Data. JAIDS: Journal of Acquired Immune Deficiency Syndromes, 79 (1), 20-27.

Abstract

Objective: School attendance prevents HIV and herpes simplex virus-2 (HSV-2) in adolescent girls and young women, but the mechanisms to explain this relationship remain unclear. Our study assesses the extent to which characteristics of sex partners, partner age, and number mediate the relationship between attendance and risk of infection in adolescent girls and young women in South Africa.

Design: We use longitudinal data from the HIV Prevention Trials Network 068 randomized controlled trial in rural South Africa, where girls were enrolled in early adolescence and followed in the main trial for more than 3 years. We examined older partners and the number of partners as possible mediators.

Methods: We used the parametric g-formula to estimate 4-year risk differences for the effect of school attendance on the cumulative incidence of HIV/HSV-2 overall and the controlled direct effect (CDE) for mediation. We examined mediation separately and jointly for the mediators of interest.

Results: We found that young women with high attendance in school had a lower cumulative incidence of HIV compared with those with low attendance (risk difference = −1.6%). Partner age difference (CDE = −1.2%) and the number of partners (CDE = −0.4%) mediated a large portion of this effect. In fact, when we accounted for the mediators jointly, the effect of schooling on HIV was almost removed, showing full mediation (CDE = −0.3%). The same patterns were observed for the relationship between school attendance and cumulative incidence of HSV-2 infection.

Conclusion: Increasing school attendance reduces the risk of acquiring HIV and HSV-2. Our results indicate the importance of school attendance in reducing partner number and partner age difference in this relationship.