The relationship between HIV, vulnerability, and school education in eastern Zimbabwe

Abstract

HIV severely affects children in sub-Saharan Africa. It is important to understand not only the effects of HIV on children, but also how to mitigate them and prevent future infections, with education as one possible avenue. This thesis investigates associations between HIV and education in youth participating in the Manicaland HIV/STD Prevention Project in eastern Zimbabwe from 1998 to 2011. In the first HIV prevalence survey from a general population sample of Zimbabwean children (aged 2-17 from 2009-2011), HIV prevalence was 2.1%, and was primarily due to mother-to-child transmission. Antiretroviral therapy coverage was low (<25%) and driven by a lack of diagnosis. Therefore, increased testing and diagnosis should be a priority to improve the outlook of HIV-positive children in this population. Providing context for my detailed analyses of education, I show that although education has increased over time in Zimbabwe, it suffered during the economic turmoil of the 2000s, and females consistently achieve lower education levels than males. Increasing education is important because children with educated parents are more likely to be educated themselves, and education appears to be protective against HIV, particularly for females. Conversely, orphanhood is associated with poorer educational outcomes and substance use, which is associated with higher levels of sexual risk behaviours. School enrolment, however, mitigates these effects and is associated with lower levels of substance use and risky sex. Thus, I illustrate one pathway through which education may decrease HIV risk. Moving beyond problems to their solutions, I demonstrate that schools can impact on the education and wellbeing of vulnerable children: high quality schools were associated with better education outcomes and higher wellbeing, suggesting that schools are well placed to improve children’s lives. The findings of this thesis suggest how education can support HIV-affected children and play a role in decreasing HIV in sub-Saharan Africa.