Recommendation: Promote girls’ primary and secondary education and women’s literacy

Education is key to an effective response to HIV/AIDS. Studies show that educated women are more likely to know how to prevent HIV infection, to delay sexual activity and to take measures to protect themselves. Education also accelerates behaviour change among young men, making them more receptive to prevention messages. Universal primary education is not a substitute for expanded HIV/AIDS treatment and prevention, but it is a necessary component that complements these efforts.

Using Education to Prevent HIV

Schools can be a primary source of information about prevention methods in the fight against HIV. New analysis by the Global Campaign for Education suggests that if all children received a complete primary education, the economic impact of HIV/AIDS could be greatly reduced and around 700,000 cases of HIV in young adults could be prevented each year—seven million in a decade. (1) Earlier studies show that in many countries, including the world’s poorest, the more educated and skilled young people are, the more likely they are to protect themselves and the less likely they are to engage in risky sexual behaviour. The benefits of education come from actual knowledge that students gain about HIV, from training in negotiation and life skills and from their increased ability to think critically and analyse situations before acting.

According to the Global Campaign for Education, “research shows that a primary education is the minimum threshold needed to benefit from [health information] programmes. Not only is a basic education essential to be able to process and evaluate information, it also gives the most marginalized groups in society—notably young women—the status and confidence needed to act on information and refuse unsafe sex.” (2)

A 32-country study found that women with post-primary education were five times more likely than illiterate women to know facts about HIV/AIDS. Illiterate women, on the other hand, were four times more likely to believe that there is no way to prevent HIV infection. (3) In Zambia, during the 1990s, HIV infection rates fell by almost half among educated women but showed little decline for women with no formal schooling.

Also in Zambia, other studies have shown that the more schooling young people have, the less likely they are to have casual partners and the more likely they are to use condoms.5 Other countries show similar patterns. In 17 countries in Africa and four in Latin America, better-educated girls tended to delay having sex and were more likely to insist that their partner use a condom. (6)

In contrast, unequal access to education, with fewer girls attending school than boys, correlates with higher infection rates among both men and women. A study in 72 capital cities found significantly higher infection rates where the literacy gap between women and men was large, (7) and another study indicated that countries where the literacy gap between girls and boys was above 25 per cent were more likely to have generalized epidemics than countries with a smaller gap. (8)


Education has an impact on young women’s risk of contracting HIV. It can affect HIV rates and change women’s lives by:

Reducing poverty
In Zambia, rural women with no education are twice as likely to be living in extreme poverty as those who have benefited from eight or more years of education.

Improving the health of women and their children
Educated mothers make more use of health care facilities, including the health services that effectively prevent fatal childhood diseases. Worldwide, the risk of a child dying prematurely is reduced by around 8 per cent for each year that its mother spent in primary school.

Delaying marriage
In Bangladesh and Ethiopia, increasing education has played a vital role in reducing child marriage, in part by ensuring that girls have access to the information and social networks that can protect them.

Reducing female genital cutting (FGC)
Educated women are less than half as likely to be subjected to FGC and four times more likely to oppose FGC for their daughters.

Increasing self-confidence and decision-making power
Evidence from across the world shows that, though women everywhere continue to be constrained by unequal power relations, increased education helps women to gain in status and secure greater decisionmaking power in the family and the wider community.


Much of the research that has focused on women and education also shows that post-primary education has the most impact, providing the greatest pay-off for women’s empowerment. Higher levels of education provide much more than specific information on HIV transmission. They also provide adults and young people with the larger life skills they need to make informed choices and to develop both economic and intellectual independence. Girls and women gain self-esteem along with knowledge.

They are able to prepare for the work force, better able to protect their families’ health and less likely to die during childbirth than those who are less educated. They are also more likely to marry at a later age. Girls with less than seven years of schooling are more likely to be married by age 18, and early marriage is directly linked to an increased risk of HIV infection. (9)

Higher levels of education also seem to reduce—though not eliminate—girls’ and women’s risk of violence, another predictor of HIV infection (see Chapter 6). Regarding specific knowledge about HIV, a study conducted in Uganda over the course of the 1990s showed that both women and men who finished secondary school were seven times less likely to contract HIV than those who received little or no schooling. (10)

Despite the overwhelming evidence of education’s importance in helping to limit the spread of HIV, a recent worldwide study found that about 40 per cent of countries have not yet taken the basic step of including information about AIDS in their school curriculum. (11) Nevertheless, there have been some notable successes where such programmes have been introduced.

The Government of Uganda estimates that approximately 10 million young people receive AIDS education in the nation’s classrooms, many of whom entered school for the first time when fees were eliminated in the 1990s. In one school district more than 60 per cent of students aged 13 to 16 had reported that they were sexually active in 1994. By 2001, that figure was reduced to fewer than 5 per cent. (12)

As part of its outreach to young people, Uganda also has a lively monthly newspaper called Straight Talk that contains articles on sexuality and intimacy written by secondary school students. (13) Botswana, where girls are four times more likely than boys to be HIV-positive, has also created innovative programmes. (14) It is currently training students to become peer facilitators for gender-sensitive clubs that will be based in public schools.

In Brazil, when HIV prevalence rates for teenage girls aged 13 to 19 shot up 75 per cent from 1991 to 2000, government officials turned to the secondary schools to build awareness of HIV and modes of transmission. Adolescents now learn about HIV prevention, often in same-sex classes so they can feel free to discuss fears and concerns about intimacy and sexuality without embarrassment. The Government is also distributing condoms through selected secondary schools, which are teaching young women how to negotiate condom use if their partner is hesitant.

These programmes can only be effective if they reach their target audience.

Too many young people are not enrolled in school and many do not stay through the post-primary years. Globally, 115 million children do not attend primary school, and 57 per cent of them are girls. Studies find that 150 million children currently enrolled in school will drop out before completing primary school and at least two thirds will be girls. (15) In sub-Saharan Africa, more than half of girls—54 per cent—do not complete primary school. (16) And in South Asia, only one in four young women aged 15 to 19 have completed fifth grade. (17) Girls’ enrolment rates are decreasing in some of the countries hardest hit by HIV.

Children in families affected by AIDS are more likely than others to be taken out of school. Illness prevents family members from earning an income, and what little money is available for school fees often goes to cover boys’ costs first. Girls are also more likely than boys to leave school to care for family members who are ill or to support siblings when parents die of AIDS. (18) There are currently an estimated 15 million AIDS orphans around the world, and the number is expected to reach 25 million by 2010. Most of them will be unlikely to have the resources to pay school fees. (19) When extended family members step in to help, once again they often choose to pay for boys. Schools themselves are affected by HIV, making it difficult for students to get a decent education. Many schools in Africa are losing teachers to AIDS, and it is assumed that a similar pattern will develop elsewhere unless steps to slow infection rates are successful. In Zambia, three quarters of the new teachers trained each year are needed to replace those who have died of AIDS. In recent years, Malawi has lost so many teachers to AIDS that some schools have had student to teacher ratios as high as 96:1. (20)

Challenges to School-based Education
Despite the many benefits of education, there are also challenges. The environment in which girls and boys learn is as important as the fact that they are in school. Where schools do not provide a safe environment for girls, where they do not address behaviour patterns that contribute to gender disparity, there is the risk that many young women will leave school early or graduate without the skills and self-esteem they need to participate as equals in the world. In the Caribbean, which has the second highest HIV prevalence rates after sub-Saharan Africa, girls outperform boys throughout the education system, including at the university level where there are many more women graduates. Nevertheless, the rate of new infections among girls aged 15 to 19 is five times higher than that of boys of the same age group.

This ‘remarkable paradox’ between higher education levels and higher rates of HIV prevalence is tied, says Sir George Alleyne, the Secretary-General’s Special Envoy for HIV/AIDS in the Caribbean, to young women’s inability to advocate for themselves despite their years of education. “Possibly, the skills and knowledge women acquire in the formal education system are not sufficient to enable them to take control over other parts of their lives…it may come too late to prevent them from being the victim of unwanted or transactional sex as adolescents,” he says. 21

A study by PAHO shows in fact that fully half of all young women in the Caribbean report that their first sexual encounter was forced or coerced. In the same study, only a third of respondents were worried about acquiring HIV, indicating that both young men and young women need a deeper understanding of their vulnerability to infection. (22)
In too many instances, schools are the places where girls first experience discrimination, sexual harassment and abuse, either from other students or from teachers.

These pressures are common in schools throughout the world, but young women generally find a way to stay in school in the developed world. In poorer nations, where it may not be easy to transfer or where there is less accountability, girls frequently drop out of school. Reports indicate that approximately one-third of schoolgirls in Johannesburg have been subjected to sexual violence at school. (23) An Africa Rights report identified cases of teachers demanding sexual favours in return for good grades in several countries, including the Democratic Republic of the Congo, Ghana, Nigeria, Somalia, South Africa, Sudan, Zambia and Zimbabwe. (24) Research in Kenya has also shown that teachers undermine girls in the classroom, contributing to the girls’ feelings that they do not belong in school. (25) In many cases, a vicious cycle is created where girls who drop out of school are then more vulnerable to unwanted pregnancy and STIs, including HIV/AIDS.

To be most effective in reducing the impact of HIV/AIDS, education systems must be transformed.
Their mandate must include imparting more than pure knowledge. They should challenge gender stereotypes and misinformation, train girls in skills that can provide economic opportunities, reinforce girls’ participation and empowerment and promote knowledge of sexual and reproductive health, including ways to prevent unwanted pregnancy, STIs and HIV/AIDS. This transformation of education systems requires changes to the existing curriculum, specialized training for teachers, outreach to communities and parents, a stronger link between schools and health care systems, and flexible timetables for HIV-infected children.

Change is under way in many countries, both in terms of improving education about HIV/AIDS and increasing access to schooling. In Viet Nam, the Government has decided to include reproductive health and HIV/AIDS education in the national curriculum for grades 10 through 12. This model programme also trains teachers and is developing a special curriculum on adolescent reproductive health. Some governments are abolishing school fees. When Kenya eliminated its US$133 annual tuition and $27 uniform fee in 2003, more than 1.3 million children entered school for the first time. Malawi, Uganda and Tanzania have also instituted free primary education, and several of these countries hope to make secondary schools free also. (26)

Even without fees, many school districts will have to offer incentives to families to make it financially feasible for them to send their daughters to school. Some areas have experimented successfully with offering food or cash incentives to families in order to keep their daughters in school, instead of putting them to work in the home or as wage earners. Efforts to keep all children in school and make it easier for girls to attend will substantially reduce poverty, child mortality, HIV/AIDS and other diseases.