Education Isn't Free in Africa
The Impact of Girl's
Education on HIV and Sexual Behaviour
Action Aid Press Relaease
This year marks the 25th anniversary
of the first diagnosis of AIDS. This year, over one
hundred countries pledged to ensure universal access to
AIDS prevention, treatment and care by 2010.However,
despite these grand promises, countries and donors are
failing to launch the type of large-scale prevention
efforts that are needed to reverse the spread of HIV.
The AIDS epidemic continues to
evolve, staying one step ahead of our attempts to
prevent it. There are 13,500 new HIV infections every
day. One of the latest facets of this dynamic disease is
the increasing feminisation of AIDS: in Africa, where
the HIV and AIDS epidemic has hit hardest, 74% of young
people living with HIV are women.
HIV prevention campaigns often fail
to address the increased vulnerability of young women
because they fail to deal with the simple fact that many
women lack the power to determine who to have sex with,
or when and how to have sex. The new challenge is how to
empower young women to assert their sexual and
reproductive rights. Of the possible solutions, giving
girls an education is widely recognised as the best way
to provide this girl power.
However, in the rush to tackle the
AIDS crisis, our response has forged ahead of the
evidence, especially as some of the research on girls'
education and vulnerability to HIV has yielded mixed
results. The most rigorous way to make sense of the
different pieces of evidence is to conduct a systematic
review examining all possible evidence according to a
predetermined set of criteria. To date, there has only
been one such review, which was conducted four years ago
a long time in the context of a rapidly evolving AIDS
Given the importance of basing our
response to HIV on solid evidence, ActionAid
collaborated with the researcher from the original
review James Hargreaves and conducted a systematic
review of all the research published between 1990 and
2006 in eastern, southern and central Africa to address
the following research questions:
1 What is the impact of girls'
education on sexual behaviour and HIV?
2 What difference does primary
or secondary education make to women's vulnerability to
3 What are some of the
possible mechanisms underlying the relationship between
HIV and girls' education?
The results show strong evidence
that, early in the epidemic (before 1995), more highly
educated women were more vulnerable to HIV than women
who were less well educated. The most likely reason is
that more highly educated people had better economic
prospects, which influenced their lifestyle choices such
as mobility and number of sexual partners. They were
also more likely to live in urban areas where HIV
prevalence rates were highest. At that stage, there was
also a general information vacuum about HIV and AIDS in
However, as the epidemic has evolved,
the relationship between girls' education and HIV has
also changed. Now, more highly educated girls and women
are better able to negotiate safer sex and reduce HIV
rates. The more education the better. Across all the countries reviewed, girls who had
completed secondary education had a lower risk of HIV
infection and practised safer sex than girls who had
only finished primary education. Put simply, education
is key to building "girl power"! There are also
inter-generational benefits of education, with more
highly educated adults having a positive bearing on
young women's condom use. Moreover, more education
empowers boys and men to practise safer sex, thus
reducing their own, and their partners', risk of
Despite the power of girls' education
and numerous international commitments to education, the
reality is that the vast majority of girls in Africa
will not complete primary education, let alone manage to
get to secondary school.
A key obstacle is the rising cost
of education. Most children in Africa have to pay to
go to primary school, paying increasing amounts as they
rise through the grades, particularly if they enter
secondary school. This leads to the exclusion of many
children from education, especially girls.
If we are to see the real benefits of
educating girls, then fees need to be removed and
governments and donors need to be urged to invest more
in primary and secondary education. Any increase in
funding to education should not be seen as an
alternative to the universal goals of HIV prevention,
care and treatment but rather as a complementary
response that lays a solid foundation for our HIV
The gap between the epidemic and the
response is - in some countries - narrowing. This report
shows that it is possible to stay ahead of the virus but
only when individuals (particularly women and girls)
have the power to choose who they have sex with, and
when and how they do so. Educating girls and women is
one huge step towards turning around the AIDS epidemic
Summary of results
Formal education can influence
vulnerability to HIV in five different ways:
1 Expose girls to HIV and AIDS
education, which helps prevent HIV.
2 Provide psychosocial benefits for
young women, helping them to build their self-esteem and
capacity to act on HIV prevention messages.
3 Lead to better economic prospects,
which in turn lead to lifestyle changes that can
influence HIV vulnerability.
4 Influence the level of power within
5 Affect the social and sexual
networks of girls.
Impact of girls' education on HIV
In total, over 600 articles were
identified for the review, of which only 45 met the
review criteria. Of these, 22 articles examined the
impact of education on HIV rates and revealed the
* Before 1995, 10 out of 13 articles
showed girls' education had a negative impact on HIV
infection rates (more education, more HIV).
* After 1995, none of the research
showed more highly educated women to have higher rates
of HIV infection. Half of the articles reviewed showed
no association between HIV and education, and the other
half showed girls' education to have a positive impact
on HIV vulnerability (more education, less HIV).
* An additional five studies examined
HIV rates over time and found HIV vulnerability to be
decreasing in the most educated groups and increasing or
remaining stable in the least educated groups.
These findings suggest that the
impact of girls' education on HIV is changing as the
epidemic evolves. The evidence shows that, as the
epidemic matures, the impact of girls' education
reverses and starts having a positive impact. This
changing relationship between education and HIV rates is
strongly supported by studies taken over time in four
countries. A change is occurring in which more highly
educated women are becoming less vulnerable to HIV and
at the same time, less well educated women are becoming
Impact of girls' education on
The studies looked at a wide range of
sexual behaviour outcomes and the results can be
summarised as follows:
* Six out of eight articles showed
that girls who had received more education were more
likely to start having sex at a later age. None of the
articles showed a link between more education and
earlier sexual activity or sexual debut.
* 10 out of 13 articles showed that
higher levels of girls' education were related to higher
levels of condom use. Again, none of the articles
suggested that more education might lead to less condom
* Education was also related to
levels of coercive sex, transactional sex, age
difference between partners, and relationships with
commercial sex workers. However, the number of studies
are too small to find any trends.
The most striking finding is that
more highly 5 educated women are more likely to use
condoms during sex. The finding on earlier sexual
activity is slightly more difficult to interpret as it
is also likely that the relationship actually works the
other way: earlier sexual activity impacts negatively on
education. Put simply, young women who are sexually
active are more likely to get pregnant and therefore
drop out of school.
Boys' or girls' education?
Is the impact of education on HIV
vulnerability different for young women and men? Our
analysis shows no striking gender differences. The fact
that education helps to protect against HIV holds true
as much for boys as for girls. Although the focus of
this report is on young women, empowering young men
through education is as much a part of the solution to
the HIV epidemic as targeting young women.
However, focusing on girls' education
remains important as girls tend to have less access to
education and are therefore more vulnerable to HIV and
Primary or secondary education?
There were six studies that compared
the results for primary and secondary education. In all
of these studies, completion of secondary education was
related to lower HIV risk, more condom use and fewer
sexual partners compared with completion of primary
education. These results tentatively suggest that more
education is linked to better protection against HIV.
The relative importance of investing
more resources in primary or secondary education is less
clear but self-evidently, no girl will be able to access
secondary school unless she has been to primary school.
Tens of millions of girls are still excluded even from
the first grade at school.
Of course, it should be noted that
even when they have completed secondary education, women
are still vulnerable to HIV infection. In other words,
education helps protect women but many other measures
are also needed.
Very few of the studies reviewed
attempted to look at the underlying mechanisms through
which girls' education might impact on HIV
vulnerability. The scant evidence that does exist
suggests that increased condom use is likely to be a
factor. Economic status is clearly also a factor,
although it is hard to separate this from education.
Eight studies tried to show the relative strengths of
education and economic status and their bearing on HIV
* One study shows education is more
important than economic status.
* Two studies show economic status is
more important than education.
* Five studies show it is impossible
to separate education and economic status.
1 Prevention messages need to
address gender and power dynamics within sexual
relationships, so that both girls and boys can become
confident enough to overcome negative stereotyping and
2 The education sector
response to HIV and AIDS needs to be prioritised and all
schools should provide comprehensive sexual health
education with a special focus on HIV and family
planning. Promoting condoms is a message that is working
and should be encouraged.
3 Schools should foster gender
equality, promote positive role models and challenge
negative gender stereotyping. Zero tolerance should be
shown towards sexual violence and towards teachers
having sexual relationships with students.
4 Schools need to respond to
the problem of teenage pregnancy by providing
comprehensive sex education to reduce pregnancy and
improve sexual health. Part of the response should
include policies on how to encourage teenage mothers to
return to education.
5 In order to expand girls'
education, all forms of school fees in primary education
should be abolished. This policy must be accompanied by
adequate planning and resources to cover the loss in
funding from the fees and also to meet the increased
demand when education becomes free. The quality of
education provision must not suffer and governments
should resist the practise of hiring non-professional
6 Expansion of the Fast Track
Initiative (FTI) a pledge made by the international
community to make sure that all countries have enough
resources to provide basic education should be
encouraged. Donors need to prioritise filling the
immediate resource gap in FTI ($510 million) and the
long-term gap of $10 billion.
7 Macroeconomic constraints
that prevent governments from expanding their spending
on girls' education need to be removed. To get all girls
into school and to keep them there requires the
recruitment of millions of new professional teachers.
This means lifting public sector wage bill caps imposed
by the International Monetary Fund (IMF) and generating
open public debate about the trade-offs between driving
towards low inflation targets and ensuring adequate
spending on education and HIV and AIDS.
8 More focus needs to be
placed on removing the bottlenecks between completion of
primary school and access to secondary school,
particularly for girls. This will require significant
expansion of secondary schooling in many countries and
specific interventions to remove the obstacles faced by
girls wishing to continue their education.
9 More research on young
people, HIV vulnerability and teenage pregnancy is
desperately needed. All data should be separated by
gender. More longitudinal studies are also needed to
understand the reasons why education might protect
against HIV, as well as research comparing the impact of
primary and secondary education on HIV vulnerability.
Finally, systematic reviews of existing literature
should be encouraged in order to build upon the research
that already exists, rather than reinventing the wheel.
* * *
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posted 23 September 2006