School Enrollment and Marriage Delays Coincide With HIV Rates

In a study conducted at the Mailman School of Public Health researchers tracked trends in risk factors for HIV infection among youth in Rakai, Uganda to gain insights on preventing future cases of HIV infection. Results show that dramatic decreases in HIV incidence occurred among teen women in Rakai, however these behaviors did not translate into declines in HIV incidence among young adult women or young men.

The substantial declines for teenage women coincided with a decline in HIV prevalence, decreased risk behaviors, increased school enrollment, delay in marriage, and primary abstinence. Findings from the paper, "Behavioral, Biological, and Demographic Risk and Protective Factors for New HIV Infections among Youth, Rakai, Uganda,” are published online in JAIDS.

Using behavioral, demographic, and biological data from the Rakai Community Cohort Study from 1999-2011, the researchers studied sexually experienced youth from the ages of 15 to 24 years of age.  They found that HIV prevalence declined steadily from 9.1% to 6.1% among this category of teenage women. For teen women aged 15 to 19, HIV incidence decreased by 86% but did not change among young adult women (20-24 years). For young men, HIV incidence and prevalence were consistently lower than in young women, but did not change over time.

As school enrollment increased and marriage rates declined substantial decreases occurred in sexual experience for both teen men and teen women. For the entire sample of sexually experienced youth, there was a sizeable drop-off in numbers of multiple partners. Among young men, ages 15 to 24, sex with simultaneous partners declined and circumcision increased - as the practice became more available. However, consistent condom use showed little change over time. Notably, while the entire decline in sexual experience was attributable to increasing levels of school enrollment, about 70% of the drop in HIV incidence among teen women was attributable to reduced sexual experience.

“We’re seeing remarkable behavior change among youth in the Rakai district over the last 10 years,” said John S. Santelli, MD, MPH, professor and chair of the Heilbrunn Department of Population and Family Health.  “And the data substantiates that the rising access to education for teenagers is a key driver to this shift.”

Study findings from the Rakai Youth Project were presented in December at the Society for Adolescent Health meeting in Kampala, Uganda.