# Investing In Secondary Schooling To Reduce HIV Risk

> **NIH NIH R03** · BOSTON UNIVERSITY MEDICAL CAMPUS · 2020 · $82,500

## Abstract

Project Summary
Secondary education has been hailed as a “social vaccine” against HIV acquisition, particularly for young
women who continue to experience high HIV incidence in sub-Saharan Africa. Education may provide HIV
information, health literacy, and economic empowerment, reducing risks of transactional sex. Yet until recently
evidence on the relationship between education and HIV risk was limited to correlational studies, vulnerable to
confounding. In a recent paper in Lancet Global Health, we evaluated a natural experiment in Botswana,
generating some of the first causal evidence linking education levels to reduced HIV infection rates.
In 1996, Botswana changed the grade structure of secondary school, shifting grade 10 from senior secondary
to junior secondary. Because there are many more junior secondary schools, this policy sharply reduced
distance to the nearest grade 10 classroom and resulted in a 0.8-year increase in total years of schooling for
affected birth cohorts. Exploiting this exogenous variation in education, we found that birth cohorts entering
secondary school in or after 1996 had significantly lower risk of HIV infection when contacted in later
population-based biomarker surveys. One additional year of schooling resulting from the reform reduced the
10-year cumulative incidence of HIV from 25% to 18%. Our findings were cited by PEPFAR/USAID in
allocating over $100M to support secondary school expansion for HIV prevention, as part of the DREAMS
initiative and the recently announced Secondary Education Expansion for Development (SEED) initiative.
Building on this foundation, this R03 proposal for “Secondary Analyses of Existing Datasets” will determine the
proximate behaviors (Aim 1) and the distal mechanisms for behavior change (Aim 2) that explain the
impact of Botswana’s schooling reform on reduced HIV acquisition. To implement the proposed research, we
have compiled a rich array of secondary datasets not available to us in our original study, including all four
waves of the Botswana AIDS Impact Survey, four Botswana Censuses, and two Botswana Labor Force
Surveys, which provide measures of proximate and distal mechanisms. We will analyze the data using the
same econometric approach that we implemented in our original study. Our hypothesis is that secondary
schooling shifted fertility and labor market preferences, leading to economic independence and lower HIV risk.
There is a critical need to understand the mechanisms through which secondary education reduces
HIV risk. The proposed research will shed light on whether the lessons from Botswana can be generalized to
other settings and what mechanisms should be targeted by future education reforms for maximum HIV impact.

## Key facts

- **NIH application ID:** 10004115
- **Project number:** 5R03HD098982-02
- **Recipient organization:** BOSTON UNIVERSITY MEDICAL CAMPUS
- **Principal Investigator:** Jacob Bor
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $82,500
- **Award type:** 5
- **Project period:** 2019-09-01 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10004115

## Citation

> US National Institutes of Health, RePORTER application 10004115, Investing In Secondary Schooling To Reduce HIV Risk (5R03HD098982-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10004115. Licensed CC0.

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