Multilevel measures of education and pathways to incident herpes simplex virus type 2 in adolescent girls and young women in South Africa
Stoner, M. C. D., Neilands, T. B., Kahn, K., Hughes, J. P., Gómez-Olivé, F. X., Twine, R., Tollman, S., Laeyendecker, O., MacPhail, C., Ahern, J., Lippman, S. A., & Pettifor, A. (2019). Multilevel measures of education and pathways to incident herpes simplex virus type 2 in adolescent girls and young women in South Africa. Journal of Adolescent Health, 65(6), 723-729. https://doi.org/10.1016/j.jadohealth.2019.06.008
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.