The effect of increased primary schooling on adult women's HIV status in Malawi and Uganda: Universal Primary Education as a natural experiment.

This paper explores the causal relationship between primary schooling and adult HIV status in Malawi and Uganda, two East African countries with some of the highest HIV infection rates in the world. Using data from the 2010 Malawi Demographic Health Survey and the 2011 Uganda AIDS Indicator Survey, the paper takes advantage of a natural experiment, the implementation of Universal Primary Education policies in the mid 1990s. An instrumented regression discontinuity approach is used to model the relationship between increased primary schooling and adult women's HIV status. Results indicate that a one-year increase in schooling decreases the probability of an adult woman testing positive for HIV by 0.06 (p < 0.01) in Malawi and by 0.03 (p < 0.05) in Uganda. These results are robust to a variety of model specifications. In a series of supplementary analyses a number of potential pathways through which such effects may occur are explored. Findings indicate increased primary schooling positively affects women's literacy and spousal schooling attainment in Malawi and age of marriage and current household wealth in Uganda. However primary schooling has no effect on recent (adult) sexual behavior.

[1]  Shabbar Jaffar,et al.  Continued very high prevalence of HIV infection in rural KwaZulu-Natal, South Africa: a population-based longitudinal study , 2007, AIDS.

[2]  Nu Road map towards the implementation of the United Nations Millennium Declaration: report of the Secretary-General , 2002 .

[3]  N. Jewell,et al.  Female-to-male transmission of human immunodeficiency virus. , 1992, JAMA.

[4]  L. Grogan Who benefits from Universal Primary Education in Uganda , 2006 .

[5]  L. Grogan Universal Primary Education and School Entry in Uganda , 2008 .

[6]  D. Bundy,et al.  Education and vulnerability: the role of schools in protecting young women and girls from HIV in southern Africa , 2008, AIDS.

[7]  I. Kleinschmidt,et al.  Young people's sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey , 2005, AIDS.

[8]  Jonathan H. Wright,et al.  A Survey of Weak Instruments and Weak Identification in Generalized Method of Moments , 2002 .

[9]  S. Wallenstein,et al.  PRO 2000 elicits a decline in genital tract immune mediators without compromising intrinsic antimicrobial activity , 2007, AIDS.

[10]  Esther Duflo,et al.  Education, HIV, and Early Fertility: Experimental Evidence from Kenya , 2014, The American economic review.

[11]  R. Meinzen-Dick,et al.  Gender and social capital for agricultural development , 2014 .

[12]  B. Long,et al.  Does Female Schooling Reduce Fertility? Evidence from Nigeria. NBER Working Paper No. 13070. , 2007 .

[13]  D deWalque,et al.  How does the impact of an HIV / AIDS information campaign vary with educational attainment? Evidence from rural Uganda. , 2007 .

[14]  R. Meinzen-Dick,et al.  A System That Delivers: Integrating Gender into Agricultural Research, Development, and Extension , 2014 .

[15]  R. Hayes,et al.  Biological and behavioural impact of an adolescent sexual health intervention in Tanzania: a community-randomized trial , 2007, AIDS.

[16]  R. Meinzen-Dick,et al.  Gender Equity and Land: Toward Secure and Effective Access for Rural Women , 2014 .

[17]  P. Ghys,et al.  HIV infection does not disproportionately affect the poorer in sub-Saharan Africa , 2007, AIDS.

[18]  Raja Kattan Bentaouet Implementation of free basic education policy , 2006 .

[19]  P. Rose,et al.  Can free primary education meet the needs of the poor? Evidence from Malawi , 2003 .

[20]  C. Ferré Age at First Child: Does Education Delay Fertility Timing? The Case of Kenya , 2009 .

[21]  R. Meinzen-Dick,et al.  The Gender Asset Gap and Its Implications for Agricultural and Rural Development , 2014 .

[22]  S. Gregson,et al.  HIV incidence and poverty in Manicaland, Zimbabwe: is HIV becoming a disease of the poor? , 2007, AIDS.

[23]  D. Walque How Does the Impact of an HIV/AIDS Information Campaign Vary with Educational Attainment? Evidence from Rural Uganda , 2004 .

[24]  R. Garfein,et al.  Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial , 2012, The Lancet.

[25]  R. Hayes,et al.  Long-Term Biological and Behavioural Impact of an Adolescent Sexual Health Intervention in Tanzania: Follow-up Survey of the Community-Based MEMA kwa Vijana Trial , 2010, PLoS medicine.

[26]  R. Meinzen-Dick,et al.  Gender: A Key dimension LinKinG AGricuLturAL ProGrAms to imProved nutrition And HeALtH , 2011 .

[27]  A. Fletcher,et al.  Systematic review exploring time trends in the association between educational attainment and risk of HIV infection in sub-Saharan Africa , 2008, AIDS.

[28]  D. Cutler,et al.  Girls' education and HIV risk: evidence from Uganda. , 2013, Journal of health economics.

[29]  Joshua D. Angrist,et al.  Mostly Harmless Econometrics: An Empiricist's Companion , 2008 .

[30]  Barry Turner,et al.  United Nations (UN) , 2009 .

[31]  J. Glynn,et al.  Does increased general schooling protect against HIV infection? A study in four African cities , 2004, Tropical medicine & international health : TM & IH.

[32]  R. Meinzen-Dick,et al.  An Interpretation of Large-Scale Land Deals Using Boserup’s Theories of Agricultural Intensification, Gender and Rural Development , 2014 .

[33]  W. Hall,et al.  Being More Realistic about the Public Health Impact of Genomic Medicine , 2010, PLoS medicine.

[34]  R. Meinzen-Dick,et al.  Understanding Gender and Culture in Agriculture: The Role of Qualitative and Quantitative Approaches , 2014 .

[35]  J. Behrman,et al.  Out of sync? Demographic and other social science research on health conditions in developing countries. , 2011, Demographic research.

[36]  R. Meinzen-Dick,et al.  The gender implications of large-scale land deals , 2012 .

[37]  Klaus Deininger,et al.  Does cost of schooling affect enrollment by the poor? Universal primary education in Uganda , 2003 .