HIV in Cameroon: Why Are the Educated Still at Greater Risk?

HIV in Cameroon 7 Years Later: Why Are the Educated Still at Greater Risk?

By Joyce Mumah, Post-Doctoral Fellow

The latest round of the Cameroon Demographic and health survey (EDS/VIH in French)  preliminary results were just released and thankfully had mostly good news to tell: HIV rates are down-- but the question remains: Why are the educated still at a higher risk?

What does the survey tell us?

The survey tested a total of 13,503 individuals: 7,221 women (ages 15-49), 6,282 men (ages 15 – 49) and 699 men (ages 50-59) for HIV infection.  The 2011 results indicate there is an overall reduction in HIV positive prevalence from 5.5% in 2004, to currently 4.3% in 2011. Disaggregated by gender, 2.9 % of men tested positive for HIV (compared to 4.1% in 2004), while 5.6% percent of women tested positive for HIV (compared to 6.8% in 2004).

                   

Source: DHS/HIV 2011 preliminary report

What about people with more education?

Like with the 2004 HIV estimates, the educated still have higher rates in 2011. Estimates indicate that both men and women with no education have lower rates (1.7% and 2.8%, respectively) compared to individuals with primary education (3.1% and 6.6%, respectively) and secondary or more education (6.7% and 2.5%, respectively).  For women with  secondary or more education we see a slight decrease in HIV rates (5.2%), though men with secondary education or more have the highest rates for the group (3.5%).  The rate of HIV also increased significantly with age, peaking at 10% for women ages 35-39 and just a little over 6% for men ages 45-49.

More questions:

The new Cameroon HIV estimates bring back interesting questions that arose from the release of the 2004 data:

• Why are the educated still having higher rates?
• Is educating the girl child the solution?
• Why are women still having double the rates of men?
• Do these estimates drive home the point that a targeted approach is needed to cater to the educated?

Most of these questions cannot be answered from the preliminary report. A full analysis of the data, when released, should be able to give us some of the answers.

Implications of new estimates (for women especially):

The new lower estimates are a welcomed reprieve for women in Cameroon, with regards to the HIV epidemic. However, with these new results, Cameroonian women still remain susceptible, with almost twice the rate of HIV infection as their male counterparts. The implications for the new results remain complex: on the one hand lower estimates mean some of the key prevention messages may be getting to the most susceptible group; but on the other hand, the higher rates have more far reaching impacts as it affects women of reproductive ages, working adults (key income earners), children likely being orphaned, and the educated who are more likely to possess the skills necessary to sustain a productive labor force.

In the Cameroon case, however, it is worth noting that previous research does indicate that there is not a direct relationship between education and HIV, but a relationship that is impacted by other lifestyle factors and choices.  For example in Reither and Mumah, 2009[2], we found that while the relationship between education and HIV was very strong, when we controlled for other factors such as sexual attitudes, knowledge, and practices; place of residence; and variables such as age, marital status, head of household, and number of children, this relationship substantially weakened.  However, this does not discount the fact that the higher rates among women with more education remains of concern. One of the reasons for higher rates among educated women in Cameroon is attributed to their own sexual behaviors, specifically length of years engaged in premarital sexual intercourse[3]. The educated women in Cameroon were more likely to the delay marriage, but yet be sexually active.  It will therefore be of tremendous interest to explore the new data to see if behavioral factors still explain the rates among women, albeit rates lower than those of 2004.

Ultimately, whether the decline in HIV prevalence from 2004 to 2011 is significant remains to be determined, what however, remains evident from the preliminary report is the fact that behavior change remains imperative to curbing the incidence of HIV and that a one-size fits all approach to HIV/AIDS prevention is no longer viable in Cameroon.