IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v388y2026ics0277953625010512.html

Revisiting the education-HIV gradient in Africa: Cohort variation analysis of a temporal shift and speculation on causes

Author

Listed:
  • Muñoz, Ismael G.
  • Baker, David P.

Abstract

This study examines the changing relationship between education and HIV in Africa over time. While a negative relationship between education and morbidity is generally well-established, conflicting reports on the education-HIV gradient in Africa raised doubts about its consistency. Studies found positive, null, or negative gradients, suggesting that education might not influence HIV risk as expected. This paper argues that these conflicting findings could reflect a temporal shift in the education-HIV gradient, rather than errors in epidemiological data. Using Demographic and Health Surveys and a cohort analysis of 304,630 individuals from eight African countries, the study shows that, initially, education was linked to higher HIV infection rates for those born between 1960 and 1984, peaking in the 1965-69 cohort. However, from those born between 1985 and 1989 onward, education became protective, with gradients becoming stronger over time. This temporal shift is not sensitive to regional differences and methodologies and is corroborated by similar shifts for other risky behaviors. Additional hypothesized cohort variations for males and females, as well as countries with differing levels of HIV mitigation efforts, suggest potential drivers behind this shift. The dynamic ways in which education is associated with health adds complexity to the fundamental cause theory.

Suggested Citation

  • Muñoz, Ismael G. & Baker, David P., 2026. "Revisiting the education-HIV gradient in Africa: Cohort variation analysis of a temporal shift and speculation on causes," Social Science & Medicine, Elsevier, vol. 388(C).
    • Handle: RePEc:eee:socmed:v:388:y:2026:i:c:s0277953625010512
    DOI: 10.1016/j.socscimed.2025.118720
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953625010512
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2025.118720?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to

    for a different version of it.

    References listed on IDEAS

    as
    1. Hayward, Mark D. & Hummer, Robert A. & Sasson, Isaac, 2015. "Trends and group differences in the association between educational attainment and U.S. adult mortality: Implications for understanding education's causal influence," Social Science & Medicine, Elsevier, vol. 127(C), pages 8-18.
    2. Behrman, Julia Andrea, 2015. "The effect of increased primary schooling on adult women's HIV status in Malawi and Uganda: Universal Primary Education as a natural experiment," Social Science & Medicine, Elsevier, vol. 127(C), pages 108-115.
    3. Laura Dwyer-Lindgren & Michael A. Cork & Amber Sligar & Krista M. Steuben & Kate F. Wilson & Naomi R. Provost & Benjamin K. Mayala & John D. VanderHeide & Michael L. Collison & Jason B. Hall & Molly H, 2019. "Mapping HIV prevalence in sub-Saharan Africa between 2000 and 2017," Nature, Nature, vol. 570(7760), pages 189-193, June.
    4. Reither, Eric N. & Hauser, Robert M. & Yang, Yang, 2009. "Do birth cohorts matter? Age-period-cohort analyses of the obesity epidemic in the United States," Social Science & Medicine, Elsevier, vol. 69(10), pages 1439-1448, November.
    5. Robert J. Brent, 2014. "Female Education, HIV/AIDS and Th e Education Vaccine in Sub-Saharan Africa: The Condoms Piece of the Puzzle," Journal of African Development, African Finance and Economic Association (AFEA), vol. 16(2), pages 41-71.
    6. Cutler, David M. & Lleras-Muney, Adriana, 2010. "Understanding differences in health behaviors by education," Journal of Health Economics, Elsevier, vol. 29(1), pages 1-28, January.
    7. Jorge M. Agüero & Prashant Bharadwaj, 2014. "Do the More Educated Know More about Health? Evidence from Schooling and HIV Knowledge in Zimbabwe," Economic Development and Cultural Change, University of Chicago Press, vol. 62(3), pages 489-517.
    8. David P. Baker & Juan Leon & Emily G. Smith Greenaway & John Collins & Marcela Movit, 2011. "The Education Effect on Population Health: A Reassessment," Population and Development Review, The Population Council, Inc., vol. 37(2), pages 307-332, June.
    9. Denis Cogneau & Michael Grimm, 2006. "Socioeconomic status, sexual behavior, and differential AIDS mortality: evidence from Côte d’Ivoire," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 25(4), pages 393-407, August.
    10. Dunkle, Kristin L. & Jewkes, Rachel & Nduna, Mzikazi & Jama, Nwabisa & Levin, Jonathan & Sikweyiya, Yandisa & Koss, Mary P., 2007. "Transactional sex with casual and main partners among young South African men in the rural Eastern Cape: Prevalence, predictors, and associations with gender-based violence," Social Science & Medicine, Elsevier, vol. 65(6), pages 1235-1248, September.
    11. David P. Baker & William C. Smith & Ismael G. Muñoz & Haram Jeon & Tian Fu & Juan Leon & Daniel Salinas & Renata Horvatek, 2017. "The Population Education Transition Curve: Education Gradients Across Population Exposure to New Health Risks," Demography, Springer;Population Association of America (PAA), vol. 54(5), pages 1873-1895, October.
    12. Fairbrother, Malcolm, 2014. "Two Multilevel Modeling Techniques for Analyzing Comparative Longitudinal Survey Datasets," Political Science Research and Methods, Cambridge University Press, vol. 2(1), pages 119-140, April.
    13. Kasim Allel & Gerard Joseph Abou Jaoude & Charles Birungi & Tom Palmer & Jolene Skordis & Hassan Haghparast-Bidgoli, 2022. "Technical efficiency of national HIV/AIDS spending in 78 countries between 2010 and 2018: A data envelopment analysis," PLOS Global Public Health, Public Library of Science, vol. 2(8), pages 1-23, August.
    14. Simon Gregson & Heather Waddell & Stephen Chandiwana, 2001. "School education and HIV control in sub-Saharan Africa: from discord to harmony?," Journal of International Development, John Wiley & Sons, Ltd., vol. 13(4), pages 467-485.
    15. Damien de Walque, 2010. "Education, Information and Smoking Decisions: Evidence from Smoking Histories in the United States, 1940–2000," Journal of Human Resources, University of Wisconsin Press, vol. 45(3).
    16. de Walque, Damien, 2007. "How does the impact of an HIV/AIDS information campaign vary with educational attainment? Evidence from rural Uganda," Journal of Development Economics, Elsevier, vol. 84(2), pages 686-714, November.
    17. Peter J. Glick & David E. Sahn, 2008. "Are Africans Practicing Safer Sex? Evidence from Demographic and Health Surveys for Eight Countries," Economic Development and Cultural Change, University of Chicago Press, vol. 56(2), pages 397-439, January.
    18. Jane Fortson, 2008. "The gradient in sub-saharan Africa: Socioeconomic status and HIV/AIDS," Demography, Springer;Population Association of America (PAA), vol. 45(2), pages 303-322, May.
    19. Damien de Walque, 2009. "Does Education Affect HIV Status? Evidence from five African Countries," The World Bank Economic Review, World Bank, vol. 23(2), pages 209-233, June.
    20. Barbara S. Mensch & Monica J. Grant & Erica Soler-Hampejsek & Christine A. Kelly & Satvika Chalasani & Paul C. Hewett, 2020. "Does schooling protect sexual health? The association between three measures of education and STIs among adolescents in Malawi," Population Studies, Taylor & Francis Journals, vol. 74(2), pages 241-261, June.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. David P. Baker & William C. Smith & Ismael G. Muñoz & Haram Jeon & Tian Fu & Juan Leon & Daniel Salinas & Renata Horvatek, 2017. "The Population Education Transition Curve: Education Gradients Across Population Exposure to New Health Risks," Demography, Springer;Population Association of America (PAA), vol. 54(5), pages 1873-1895, October.
    2. Bhandari, Aarushi & Burroway, Rebekah, 2023. "Hold the phone! A cross-national analysis of Women's education, mobile phones, and HIV infections in low- and middle-income countries, 1990–2018," Social Science & Medicine, Elsevier, vol. 334(C).
    3. Elodie Djemai & Yohan Renard & Anne-Laure Samson, 2023. "Mothers and fathers: education, co-residence, and child health," Journal of Population Economics, Springer;European Society for Population Economics, vol. 36(4), pages 2609-2653, October.
    4. Juan Leon & David P. Baker & Daniel Salinas & Adrienne Henck, 2017. "Is education a risk factor or social vaccine against HIV/AIDS in Sub-Saharan Africa? The effect of schooling across public health periods," Journal of Population Research, Springer, vol. 34(4), pages 347-372, December.
    5. Ibrahim Kasirye, 2016. "HIV/AIDS Sero-prevalence and Socio-economic Status: Evidence from Uganda," African Development Review, African Development Bank, vol. 28(3), pages 304-318, September.
    6. Daniela Iorio & Raül Santaeulàlia-Llopis, 2015. "Education, HIV Status, and Risky Sexual Behavior: How Much Does the Stage of the HIV Epidemic Matter?," Working Papers 624, Barcelona School of Economics.
    7. Yao Yao, 2022. "Fertility and HIV Risk in Africa," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 45, pages 109-133, July.
    8. Jennifer Karas Montez & Kaitlyn Barnes, 2016. "The Benefits of Educational Attainment for U.S. Adult Mortality: Are they Contingent on the Broader Environment?," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 35(1), pages 73-100, February.
    9. Sana Khan & Gianna Claudia Giannelli & Lucia Ferrone, 2024. "Can Maternal Education Enhance Children's Dietary Diversity and Nutritional Outcomes? Evidence from 2003 Education Reform in Kenya," Working Papers - Economics wp2024_12.rdf, Universita' degli Studi di Firenze, Dipartimento di Scienze per l'Economia e l'Impresa.
    10. Yao, Yao, 2016. "Fertility and HIV risk in Africa," Working Paper Series 19501, Victoria University of Wellington, School of Economics and Finance.
    11. David Mmopelwa & Oliver Morrissey & Trudy Owens, 2021. "HIV/AIDS and sexual behaviour in Botswana," Discussion Papers 2021-03, University of Nottingham, CREDIT.
    12. Esther Duflo & Pascaline Dupas & Michael Kremer, 2015. "Education, HIV, and Early Fertility: Experimental Evidence from Kenya," American Economic Review, American Economic Association, vol. 105(9), pages 2757-2797, September.
    13. Miao Li & Weidong Wang, 2021. "Educational Disparities in COVID-19 Prevention in China: The Role of Contextual Danger, Perceived Risk, and Interventional Context," IJERPH, MDPI, vol. 18(7), pages 1-14, March.
    14. Elaine M. Hernandez & Mike Vuolo & Laura C. Frizzell & Brian C. Kelly, 2019. "Moving Upstream: The Effect of Tobacco Clean Air Restrictions on Educational Inequalities in Smoking Among Young Adults," Demography, Springer;Population Association of America (PAA), vol. 56(5), pages 1693-1721, October.
    15. Smith, William C. & Anderson, Emily & Salinas, Daniel & Horvatek, Renata & Baker, David P., 2015. "A meta-analysis of education effects on chronic disease: The causal dynamics of the Population Education Transition Curve," Social Science & Medicine, Elsevier, vol. 127(C), pages 29-40.
    16. Hoffmann, Roman & Muttarak, Raya, 2017. "Learn from the Past, Prepare for the Future: Impacts of Education and Experience on Disaster Preparedness in the Philippines and Thailand," World Development, Elsevier, vol. 96(C), pages 32-51.
    17. Brendan Maughan-Brown & Neil D. Lloyd & Jacob Bor & Atheendar S. Venkataramani, 2015. "Increasing access to HIV testing: Impacts on equity of coverage and uptake from a national campaign in South Africa," SALDRU Working Papers 145, Southern Africa Labour and Development Research Unit, University of Cape Town.
    18. Naomi Duke & Ross Macmillan, 2016. "Schooling, skills, and self-rated health: A test of conventional wisdom on the relationship between educational attainment and health," Working Papers 087, "Carlo F. Dondena" Centre for Research on Social Dynamics (DONDENA), Università Commerciale Luigi Bocconi.
    19. Jennifer Karas Montez & Anna Zajacova & Mark D. Hayward & Steven H. Woolf & Derek Chapman & Jason Beckfield, 2019. "Educational Disparities in Adult Mortality Across U.S. States: How Do They Differ, and Have They Changed Since the Mid-1980s?," Demography, Springer;Population Association of America (PAA), vol. 56(2), pages 621-644, April.
    20. Durevall, Dick & Lindskog, Annika & George, Gavin, 2015. "Education and HIV incidence among young women: causation or selection?," Working Papers in Economics 638, University of Gothenburg, Department of Economics.

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;
    ;

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:388:y:2026:i:c:s0277953625010512. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.