Browsing by Author "Rhian Twine, MPH"

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    Multilevel measures of education and pathways to incident HSV-2 in adolescent girls and young women in South Africa (HPTN 068)
    (2019-12) Marie C.D. Stoner, PhD; Torsten B. Neilands, PhD; Kathleen Kahn, PhD; James P. Hughes, PhD; F. Xavier Gómez-Olivé, PhD; Rhian Twine, MPH; Stephen Tollman; Oliver Laeyendecker, PhD; Catherine MacPhail, PhD; Jennifer Ahern, PhD; Sheri A. Lippman; Audrey Pettifor, PhD
    Purpose: Schooling is associated with a lower risk of Herpes simplex virus type 2 (HSV-2) in adolescent girls and young women, but there is little understanding of the pathways underlying this relationship. Methods: We used data from adolescent girls and young women in South Africa enrolled in the HIV Prevention Trials Network 068 study. We tested a structural equation model where individual household and community education measures were associated directly and indirectly with incident HSV-2 through HIV knowledge, future aspirations, age-disparate partnerships, sex in the last 12 months, and condomless sex. Results: Community, household, and individual measures of schooling were all associated with incident HSV-2 infection through mediated pathways that increased the likelihood of having sex. Low school attendance (<80% of school days) increased the likelihood of having sex through increased age-disparate partnerships and reduced future aspirations. Fewer community years of education increased the likelihood of having sex through increased age-disparate partnerships. Parental education level was indirectly associated with HSV-2 overall, although we could not identify the individual pathways that were responsible for this association. Conclusions: Community and individual schooling interventions may reduce the risk of HSV-2 infection by influencing the likelihood of having sex, partner age, and future aspirations. Keywords: Adolescent girls and young women; Education; HSV-2; Mediation; Multilevel; Sexual behaviors.