Multilevel Measures of Education and Pathways to Incident Herpes Simplex Virus Type 2 in Adolescent Girls and Young Women in South Africa

TY - JOUR

T1 - Multilevel Measures of Education and Pathways to Incident Herpes Simplex Virus Type 2 in Adolescent Girls and Young Women in South Africa

AU - Stoner, Marie C.D.

AU - Neilands, Torsten B.

AU - Kahn, Kathleen

AU - Hughes, James P.

AU - Gómez-Olivé, F. Xavier

AU - Twine, Rhian

AU - Tollman, Stephen

AU - Laeyendecker, Oliver

AU - MacPhail, Catherine

AU - Ahern, Jennifer

AU - Lippman, Sheri A.

AU - Pettifor, Audrey

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: Schooling is associated with a lower risk of Herpes simplex virus type 2 (HSV-2) in adolescent girls and young women, but there is little understanding of the pathways underlying this relationship. Methods: We used data from adolescent girls and young women in South Africa enrolled in the HIV Prevention Trials Network 068 study. We tested a structural equation model where individual household and community education measures were associated directly and indirectly with incident HSV-2 through HIV knowledge, future aspirations, age-disparate partnerships, sex in the last 12 months, and condomless sex. Results: Community, household, and individual measures of schooling were all associated with incident HSV-2 infection through mediated pathways that increased the likelihood of having sex. Low school attendance (<80% of school days) increased the likelihood of having sex through increased age-disparate partnerships and reduced future aspirations. Fewer community years of education increased the likelihood of having sex through increased age-disparate partnerships. Parental education level was indirectly associated with HSV-2 overall, although we could not identify the individual pathways that were responsible for this association. Conclusions: Community and individual schooling interventions may reduce the risk of HSV-2 infection by influencing the likelihood of having sex, partner age, and future aspirations.

AB - Purpose: Schooling is associated with a lower risk of Herpes simplex virus type 2 (HSV-2) in adolescent girls and young women, but there is little understanding of the pathways underlying this relationship. Methods: We used data from adolescent girls and young women in South Africa enrolled in the HIV Prevention Trials Network 068 study. We tested a structural equation model where individual household and community education measures were associated directly and indirectly with incident HSV-2 through HIV knowledge, future aspirations, age-disparate partnerships, sex in the last 12 months, and condomless sex. Results: Community, household, and individual measures of schooling were all associated with incident HSV-2 infection through mediated pathways that increased the likelihood of having sex. Low school attendance (<80% of school days) increased the likelihood of having sex through increased age-disparate partnerships and reduced future aspirations. Fewer community years of education increased the likelihood of having sex through increased age-disparate partnerships. Parental education level was indirectly associated with HSV-2 overall, although we could not identify the individual pathways that were responsible for this association. Conclusions: Community and individual schooling interventions may reduce the risk of HSV-2 infection by influencing the likelihood of having sex, partner age, and future aspirations.

KW - Adolescent girls and young women

KW - Education

KW - HSV-2

KW - Mediation

KW - Multilevel

KW - Sexual behaviors

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U2 - 10.1016/j.jadohealth.2019.06.008

DO - 10.1016/j.jadohealth.2019.06.008

M3 - Article

C2 - 31521513

AN - SCOPUS:85071984888

JO - Journal of Adolescent Health

JF - Journal of Adolescent Health

SN - 1054-139X

ER -