This study looked at linkages between neighborhood educational attainment and HIV prevalence among young women in urban and rural areas of Zambia. Using cross-sectional survey data from 2003, 1295 women were identified from 10 urban and 10 rural clusters. A neighbourhood-level educational attainment measure was constructed by aggregating individual-level years in school. Adjustment was made for certain variables (education, currently a student, marital status, ever given birth, sexual activity, lifetime sexual partners). HIV prevalence among the women differed between urban (12.5%) and rural (6.8%) areas. Neighborhood educational attainment strongly influenced HIV infection, with prevalence decreasing with increasing educational attainment. Rural women in low educational attainment neighborhoods were 3.4 times as likely to have HIV and urban women were 1.8 times more likely than those in high educational attainment neighborhoods. However, after adjusting for age and other variables, this association was not significant among urban women. After adjusting for neighborhood educational level, the effect of individual education was protective among urban women, but was more of a risk factor for rural women. These results indicate that structural factors influence HIV risk. This should be taken into account when designing HIV programs.
BMC Public Health
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