Educational attainment and chronic HIV treatment adherence in southern and eastern Africa

Social policy makers frequently leverage formal schooling as a tool for curbing the HIV epidemic in sub-Saharan Africa. Yet, in the era of ‘Treatment as Prevention’, evidence about the association between formal education and chronic HIV care and treatment in the region remains limited. In this study, I use population-level data from the first round of the Population HIV Impact Assessment to examine the association between years of formal education and HIV treatment adherence (measured via viral load suppression) across seven southern and eastern African countries. Given persistent gender and age disparities in both education and HIV care in the region, I further test for moderation of these associations by gender and age. I find no bivariate or multivariable associations between education and viral load suppression in the pooled regional sample (N = 12,198), in country-specific analyses, and no modification of these findings by gender or age. Further, results were robust in sensitivity analyses using different measures of educational attainment. These somewhat surprising findings challenge our common understanding about education as a catalyst for improved health, and provide theoretical insights into what may drive the relationship (or lack thereof) between education and chronic health in different contexts. More research is needed into the contextual factors and countervailing mechanisms that may explain such results.