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Does Partner Selection Mediate the Relationship between School Attendance and HIV/HSV-2 among Adolescent Girls and Young Women in South Africa: An Analysis of HPTN 068 Data

Citation

Stoner, Marie C. D.; Edwards, Jessie K.; Miller, William C.; Aiello, Allison E.; Halpern, Carolyn Tucker; Julien, Aimee; Rucinski, Katherine B.; Selin, Amanda M.; Twine, Rhian; & Hughes, James P., et al. (2018). Does Partner Selection Mediate the Relationship between School Attendance and HIV/HSV-2 among Adolescent Girls and Young Women in South Africa: An Analysis of HPTN 068 Data. Journal of Acquired Immune Deficiency Syndromes, 79(1), 20-27. PMCID: PMC6092209

Abstract

OBJECTIVE: School attendance prevents HIV and HSV-2 in adolescent girls and young women (AGYW) 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 AGYW in South Africa.
DESIGN: We use longitudinal data from the HPTN 068 randomized controlled trial in rural South Africa where girls were enrolled in early adolescence and followed in the main trial for over three years. We examined older partners and number of partners as possible mediators.
METHODS: We use the parametric g-formula to estimate 4-year risk differences for the effect of school attendance on 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 to those with low attendance (risk difference=-1.6%). Partner age difference (CDE=-1.2%) and 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 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.

URL

http://dx.doi.org/10.1097/qai.0000000000001766

Reference Type

Journal Article

Year Published

2018

Journal Title

Journal of Acquired Immune Deficiency Syndromes

Author(s)

Stoner, Marie C. D.
Edwards, Jessie K.
Miller, William C.
Aiello, Allison E.
Halpern, Carolyn Tucker
Julien, Aimee
Rucinski, Katherine B.
Selin, Amanda M.
Twine, Rhian
Hughes, James P.
Wang, Jing
Agyei, Yaw
Gómez-Olivé, F. Xavier
Wagner, Ryan G.
Laeyendecker, Oliver B.
MacPhail, Catherine Lorne
Kahn, Kathleen
Pettifor, Audrey E.

PMCID

PMC6092209