Changes over Time in Sexual Behaviour among Young People with Different Levels of Educational Attainment in Tanzania

In this study, authors analysed data from two large nationally representative surveys conducted in Tanzania in 2003/2004 (4,710 respondents analysed) and 2007/2008 (6,691 analysed) to determine whether the behaviours (first sex, having more than one sexual partner in the last year, and unprotected last sex with a non-cohabiting partner) differed by educational attainment in those two time periods and whether changes over time in these behaviours differed between educational groups. The analysis focused on young people aged 15 to 24 years.

Data from the earlier years showed a higher prevalence of HIV infection among people with secondary education as compared to people with little or no formal education. In the second time period, the data showed the first group having a decreasing level of HIV prevalence, while the rate in the second group was stable. According to the authors, "Patterns of behaviour suggest that differences in HIV incidence might explain trends in HIV prevalence among different educational groups in Tanzania between 2003/2004 and 2007/2008."

"Data were collected on whether each participant had ever previously had sex during their life and, among those who reported ever sexual activity: age at first sex, the total number of sexual partners in the last year and condom use at last sex with non-spousal partners occurring during the last year....In the 2003/2004 survey, there was little evidence that educational attainment was associated with age at first sex among males....In the 2007/2008 survey, there was evidence that higher educational attainment was associated with later first sex....Among males in 2003/2004, greater educational attainment was associated with a lower prevalence of reported sex with more than one partner in the last year. A similar, though slightly stronger, association was seen in 2007/2008....Among men reporting a non-cohabiting partner there was strong evidence that men with primary or secondary education were less likely to report unprotected last sex with these partners compared to those with no education in both 2003/2004 and 2007/2008 ....The pattern among women was similar to that among men."

The "inverse equity hypothesis" from child health research is suggested to explain the changing social epidemiology of HIV incidence in Tanzania. "The inverse equity hypothesis suggests that the introduction of health interventions will tend to benefit those of the highest socioeconomic position first, only later benefiting those in lower socioeconomic groups....In countries with severe HIV epidemics, health promotion efforts provide information about the health implications of sexual activity and its link to risk of HIV infection, attempt to influence social norms around sexual behaviours and have made technologies such as male condoms more accessible. A key focus has been encouraging young people to delay their first sexual experience ("abstain"), have only one sexual partner ("be faithful") and use condoms ("condomise").

Under the inverse equity hypothesis, we might expect [the] shift in the scale of health promotion activities to have led to faster adoption of safe-sexual behaviour characteristics ...by those of higher socioeconomic position. Data on HIV prevalence seem to suggest this pattern...." The article concludes that more study is needed, suggesting the tying of mathematical models incorporating markers of socioeconomic stratification to current HIV studies.