Early in the 30-year HIV/AIDS pandemic in Sub-Saharan Africa, epidemiological studies identified formal education attainment as a risk factor: educated Sub-Saharan Africans had a higher risk of contracting HIV/AIDS than their less educated peers. Later demographic research reported that by the mid-1990s the education effect had reversed, and education began to function as a social vaccine. Recent counter-evidence finds a curvilinear pattern, with the association between educational attainment and HIV/AIDS infection changing from positive to negative across the education gradient. To reconcile these inconsistent conclusions, a hypothesis is developed and tested that education at early stages functioned as a risk factor and later functioned (and continues to function) as a social vaccine. We reason that this shift in the direction of the education effect was concurrent with changes in the public health environment in SSA that early on heightened material benefits from educational attainment but later heightened cognitive benefits from schooling. Using the 2003/2004 Demographic Health Surveys from four Sub-Saharan African countries (Cameroon, Ghana, Kenya and Tanzania), we tested this hypothesis (differential effects of schooling) using non-linear regression analysis (probit), identifying the different public health periods and controlling for confounding factors. The results support the hypothesis that the education effect shifted historically in the HIV/AIDS pandemic in SSA as we hypothesized.

中文翻译：

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在撒哈拉以南非洲，教育是否是抗艾滋病毒/艾滋病的风险因素或社会疫苗？整个公共卫生时期的学校教育效果

在撒哈拉以南非洲30年艾滋病毒/艾滋病大流行的早期，流行病学研究确定正规教育程度是一个危险因素：受过教育的撒哈拉以南非洲人感染艾滋病毒/艾滋病的风险比受教育程度较低的同龄人更高。后来的人口研究报告说，到1990年代中期，教育效果已经逆转，教育开始充当社会疫苗。最近的反证据找到了一种曲线模式，受教育程度与HIV / AIDS感染之间的关联在整个教育梯度中从正变为负。为了调和这些不一致的结论，提出并检验了一个假设，即早期教育起风险因素的作用，后来教育起社会疫苗的作用（并继续起作用）。我们认为，这种向教育效果方向转变的趋势与SSA中公共卫生环境的变化同时发生，这种变化在早期从受教育程度中获得了物质利益，但后来从学校获得了认知利益。使用来自四个撒哈拉以南非洲国家（喀麦隆，加纳，肯尼亚和坦桑尼亚）的2003/2004年人口健康调查，我们使用非线性回归分析（概率）来检验了这一假设（教育的差异影响），从而确定了不同的公共卫生周期和控制混杂因素。结果支持这样一个假设，即我们所假设的，在SSA的艾滋病毒/艾滋病大流行中，教育效果发生了历史性转变。