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Teacher and teenage school girls in Johannesburg, South Africa. (Allissa Richardson) Teacher and teenage school girls in Johannesburg, South Africa. (Allissa Richardson)

Teacher and teenage school girls in Johannesburg, South Africa. (Allissa Richardson)

Jon Greenberg
By Jon Greenberg June 24, 2016

More schooling reduces HIV risk. But by how much?

There are any number of arguments for boosting the education of girls in poorer nations. A person who knows more, regardless of gender, tends to earn more. The children of mothers with more education often do better themselves.

Sen. Tim Kaine, D-Va., added another item to the list. At a Senate hearing on June 15, 2016, Kaine said, "For every extra year that a girl stays in secondary school, her chance of getting infected with HIV/AIDS decreases by half."

As it turns out, Kaine had the general thrust right, but he went too far with the exact numbers.

Here’s what the research shows.

Botswana gave the world a natural experiment in 1996 when it changed its education policy by adding an extra year — grade 10 — to basic education. Botswana kept good records that covered both who stayed in school and their HIV status in the years that followed. Nearly two decades later, social scientists hopped on all that data. Their 2015 article in the medical journal Lancet found that among girls, the lifetime risk of HIV infection dropped by about one-third -- not one-half.

Kaine’s press office cited that Botswana study as the source behind his statement. Looking at some of the wording in the article, we can see why they might read it to say that the risk for women fell by half.

But it didn’t. We talked to one of the main researchers, Jacob Bor at Boston University’s School of Public Health, to confirm that it was reduced by one-third. Here’s the key table from that article.

Botswana.jpg

We underlined the key numbers in red. Before the reform, women had a 32.3 percent risk of catching the HIV infection. After getting the extra year of school, that risk came down by 11.6 percentage points, or roughly one-third.

We’d also note that Kaine’s statement also parted from the Botswana study in that he talked about "every extra year that a girl stays in secondary school," while the study only had data on a single extra year. To say that the risk fell for every extra year would go far beyond what the research shows.

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Still, Bor said Kaine has the right idea.

"He’s qualitatively correct, but quantitatively a little bit off," Bor said. "Also, these results are local to the incredibly high HIV prevalence in Botswana and their education reform. If you just parachute-dropped a year of extra schooling in another country, it’s not so clear you’d see the same result."

Two studies out of Uganda also give support to Kaine’s broad concept, if not his actual numbers.

Two Harvard researchers reported that between 1990 and 1995, HIV rates fell by about 13 percentage points. During that time, Uganda moved to keep children in school longer. The study said the driving factor was women delayed having sex.

"(Education) policy can explain between one-sixth and one-half of this overall decline," the authors wrote in their 2013 article. That is a wide range, but it still shows movement in the direction that Kaine described.

About a decade earlier, Damien de Walque, now at the World Bank, looked at 15 villages in Uganda. He and his colleagues found that "for girls born after 1970, one additional year of education reduced HIV incidence, that is the risk of getting infected with HIV/AIDS, by 21 percent," de Walque told us. That was for primary school, not secondary.

"Sen. Kaine’s statement is largely correct that the more additional years of education a girl receives, the less likely it is that she will be infected with HIV," de Walque said.

Our ruling

Kaine said that a woman’s risk of HIV infection fell by half for every extra year of secondary school. That statement goes too far in a couple of ways. The biggest decline in risk that any study found with any precision was about one-third. That’s substantial, but it isn’t half. And Kaine erred in saying that the effect would come with each additional year, when the underlying Botswana study only looked at a single extra year.

But in broad terms, leading researchers in the field gave Kaine points for getting the general point correct. More education has an appreciable impact in reducing a woman’s risk of contracting HIV.

We rate this claim Mostly True.

https://www.sharethefacts.co/share/b51dca6f-c24b-44c8-986f-9efec35b1a09

Our Sources

Congressional Quarterly, Senate hearing on barriers to education for girls, June 15, 2016

Lancet Global Health, Length of secondary schooling and risk of HIV infection in Botswana: evidence from a natural experiment, June 28, 2015

UNAIDS, Educate girls and fight AIDS, accessed June 17, 2016

Journal of Health Economics, Girls’ education and HIV risk: Evidence from Uganda, June 4, 2013

Damien de Walque, University of Chicago, How does educational attainment affect the risk of being infected by HIV/AIDS? September 2002

Population Reference Bureau, The Effect of Girls' Education on Health Outcomes: Fact Sheet, August 2011

National Bureau of Economic Research, Education, HIV, and Early Fertility: Experimental Evidence from Kenya, December 2014

Journal of Health Economics, Understanding Differences in Health Behaviors by Education, Oct. 31, 2009

Email interview, Damien de Walque, senior economist, Development Research Group, World Bank, June 20, 2016

Interview, Jacob Bor,  assistant professor at Boston University School of Public Health, June 20, 2016

Photo: School girls in Johannesburg, Allissa Richardson, via Flickr Creative Commons

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