According to this document, pre-1995 research on girls’ education and vulnerability to HIV yielded mixed results. Therefore, this study by ActionAid was designed to review the evidence from research published between 1990 and 2006 on the impact of girls’ education on sexual behaviour and HIV. The authors used a systematic review - examining all possible evidence according to a predetermined set of criteria in order to answer the following questions:

1) What is the impact of girls’ education on sexual behaviour and HIV?
2) What difference does primary or secondary education make to women’s vulnerability to HIV?
3) What are some of the possible mechanisms underlying the relationship between HIV and girls’ education?

The question of girls' education and its relation to HIV prevention stems from research showing that, in the early stages of the epidemic (before 1995) in sub-Saharan Africa, highly educated women were more vulnerable to HIV infection than the less educated. In this review, of 45 articles which met the review criteria, 22 articles examined the impact of education on HIV rates and revealed the following findings:

1. Before 1995, 10 out of 13 articles showed girls’ education had a negative impact on HIV infection rates (more education, more HIV).
2. After 1995, none of the research showed more highly educated women to have higher rates of HIV infection. Half of the articles reviewed showed no association between HIV and education, and the other half showed girls’ education to have a positive impact on HIV vulnerability (more education, less HIV).
3. An additional five studies examined HIV rates over time and found HIV vulnerability to be decreasing in the most educated groups and increasing or remaining stable in the least educated groups.

The authors state: "[t]hese findings suggest that the impact of girls’ education on HIV is changing as the epidemic evolves. The evidence shows that, as the epidemic matures, the impact of girls’ education reverses and starts having a positive impact. This changing relationship between education and HIV rates is strongly supported by studies taken over time in four countries. A change is occurring in which more highly educated women are becoming less vulnerable to HIV and at the same time, less well educated women are becoming more vulnerable." According to the review, no studies showed a relationship between more education and earlier sexual début, but there was evidence of higher rates of condom use relating to higher levels of girls' education.

There were six studies that compared the results for primary and secondary education. In all of these studies, completion of secondary education was related to lower HIV risk, more condom use, and fewer sexual partners compared with completion of primary education. The document states that these results tentatively suggest that more education is linked to better protection against HIV.

As stated here, "... as the epidemic has evolved, the relationship between girls' education and HIV has also changed. Now, more highly educated girls and women are better able to negotiate safer sex and reduce HIV rates. The more education the better. Across all the countries reviewed, girls who had completed secondary education had a lower risk of HIV infection and practised safer sex than girls who had only finished primary education. Put simply, education is key to building "girl power". There are also inter-generational benefits of education, with more highly educated adults having a positive bearing on young women’s condom use."

Recommendations include the following:

1. "Prevention messages need to address gender and power dynamics within sexual relationships, so that both girls and boys can become confident enough to overcome negative stereotyping and peer pressure.
2. The education sector response to HIV and AIDS needs to be prioritised and all schools should provide comprehensive sexual health education with a special focus on HIV and family planning. Promoting condoms is a message that is working and should be encouraged.
3. Schools should foster gender equality, promote positive role models and challenge negative gender stereotyping. Zero tolerance should be shown towards sexual violence and towards teachers having sexual relationships with students.
4. Schools need to respond to the problem of teenage pregnancy by providing comprehensive sex education to reduce pregnancy and improve sexual health. Part of the response should include policies on how to encourage teenage mothers to return to education.
5. In order to expand girls' education, all forms of school fees in primary education should be abolished. This policy must be accompanied by adequate planning and resources to cover the loss in funding from the fees and also to meet the increased demand when education becomes free. The quality of education provision must not suffer and governments should resist the practise of hiring non-professional teachers.
6. Expansion of the Fast Track Initiative (FTI) - a pledge made by the international community to make sure that all countries have enough resources to provide basic education - should be encouraged. Donors need to prioritise filling the immediate resource gap in FTI (US$510 million) and the long-term gap of US$10 billion.
7. Macroeconomic constraints that prevent governments from expanding their spending on girls’ education need to be removed. To get all girls into school and to keep them there requires the recruitment of millions of new professional teachers. This means lifting public sector wage bill caps imposed by the International Monetary Fund (IMF) and generating open public debate about the trade-offs between driving towards low inflation targets and ensuring adequate spending on education and HIV and AIDS.
8. More focus needs to be placed on removing the bottlenecks between completion of primary school and access to secondary school, particularly for girls. This will require significant expansion of secondary schooling in many countries and specific interventions to remove the obstacles faced by girls wishing to continue their education.
9. More research on young people, HIV vulnerability and teenage pregnancy is desperately needed. All data should be separated by gender. More longitudinal studies are also needed to understand the reasons why education might protect against HIV, as well as research comparing the impact of primary and secondary education on HIV vulnerability. Finally, systematic reviews of existing literature should be encouraged in order to build upon the research that already exists, rather than reinventing the wheel."
   

ActionAid website on March 30 2009.