The causal effect of education on HIV stigma in Uganda: Evidence from a natural experiment

Social Science and Medicine

Volumn 142, Issue , 2015, Pages 37-46

  Tsai, Alexander C ^a,b,c   Venkataramani, Atheendar S ^a,b  

^a MASSACHUSETTS GENERAL HOSPITAL   (United States)

^b HARVARD CENTER FOR POPULATION AND DEVELOPMENT STUDIES   (United States)

^c MBARARA UNIVERSITY OF SCIENCE AND TECHNOLOGY   (Uganda)

Author keywords

AIDS HIV; Behavioral interventions; Developing countries; International health; Social determinants

Indexed keywords

ACQUIRED IMMUNE DEFICIENCY SYNDROME; DEVELOPING WORLD; EDUCATION POLICY; EXPERIMENT; HUMAN IMMUNODEFICIENCY VIRUS; PRIMARY EDUCATION; PUBLIC ATTITUDE; PUBLIC HEALTH;

ADOLESCENT; ADULT; ARTICLE; EDUCATION; EFFECT SIZE; FEMALE; HEALTH SURVEY; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; MALE; OUTCOME ASSESSMENT; POLICY; POPULATION RESEARCH; SOCIAL DISTANCE; STATISTICAL ANALYSIS; STIGMA; UGANDA; ATTITUDE TO HEALTH; EDUCATIONAL STATUS; HEALTH; LEAST SQUARE ANALYSIS; MIDDLE AGED; PSYCHOLOGY; QUESTIONNAIRE; SOCIAL STIGMA; YOUNG ADULT;

UGANDA;

ADOLESCENT; ADULT; EDUCATIONAL STATUS; FEMALE; GLOBAL HEALTH; HEALTH KNOWLEDGE, ATTITUDES, PRACTICE; HIV INFECTIONS; HUMANS; LEAST-SQUARES ANALYSIS; MALE; MIDDLE AGED; SOCIAL DISTANCE; SOCIAL STIGMA; SURVEYS AND QUESTIONNAIRES; UGANDA; YOUNG ADULT;

EID: 84939484406     PISSN: 02779536     EISSN: 18735347     Source Type: Journal    
DOI: 10.1016/j.socscimed.2015.08.009     Document Type: Article

References (106)

1. Agüero J.M., Bharadwaj P. Do the more educated know more about health? Evidence from schooling and HIV knowledge in Zimbabwe. Econ. Dev. Cult. Change 2014, 62(3):489-517.
2. Alderman H., Gilligan D.O., Lehrer K. The impact of food for education programs on school participation in northern Uganda. Econ. Dev. Cult. Change 2012, 61(1):187-218.
3. Alsan M.M., Cutler D.M. Girls' education and HIV risk: evidence from Uganda. J. Health Econ. 2013, 32(5):863-872.
4. Angrist J.D., Imbens G.W., Rubin D.B. Identification of causal effects using instrumental variables. J. Am. Stat. Assoc. 1996, 91(434):444-455.
5. Babalola S., Fatusi A., Anyanti J. Media saturation, communication exposure and HIV stigma in Nigeria. Soc. Sci. Med. 2009, 68(8):1513-1520.
6. Baranov, V., Bennett, D., Kohler, H.-P. The indirect impact of antiretroviral therapy: mortality risk, mental health, and HIV-negative labor supply. J. Health Econ. In press.
7. Baranov V., Kohler H.-P. The Impact of AIDS Treatment on Savings and Human Capital Investment in Malawi 2014, University of Melbourne, Melbourne.
8. Baum C.F., Schaffer M.E., Stillman S. Instrumental variables and GMM: estimation and testing. Stata J. 2003, 3(1):1-31.
9. Baum C.F., Schaffer M.E., Stillman S. Enhanced routines for instrumental variables/generalized method of moments estimation and testing. Stata J. 2007, 7(4):465-506.
10. Behrman J.A. The effect of increased primary schooling on adult women's HIV status in Malawi and Uganda: universal primary education as a natural experiment. Soc. Sci. Med. 2015, 127:108-115.
11. Bobo L., Licari F.C. Education and political tolerance: testing the effects of cognitive sophistication and target group affect. Public Opin. Q. 1989, 53(3):285-308.
12. Bor J., Moscoe E., Mutevedzi P., Newell M.L., Barnighausen T. Regression discontinuity designs in epidemiology: causal inference without randomized trials. Epidemiology 2014, 25(5):729-737.
13. Brown L., Macintyre K., Trujillo L. Interventions to reduce HIV/AIDS stigma: what have we learned?. AIDS Educ. Prev. 2003, 15(1):49-69.
14. Campbell C., Foulis C.A., Maimane S., Sibiya Z. "I have an evil child at my house": stigma and HIV/AIDS management in a South African community. Am. J. Public Health 2005, 95(5):808-815.
15. Chan B.T., Tsai A.C., Siedner M.J. HIV treatment scale-up and HIV-related stigma in sub-Saharan Africa: a longitudinal cross-country analysis. Am. J. Public Health 2015, 105(8):1581-1587.
16. Chan B.T., Weiser S.D., Boum Y., Siedner M.J., Mocello A.R., Haberer J.E., et al. Persistent HIV-related stigma in rural Uganda during a period of increasing HIV incidence despite treatment expansion. AIDS 2015, 29(1):83-90.
17. Chiao C., Mishra V., Sambisa W. Individual- and community-level determinants of social acceptance of people living with HIV in Kenya: results from a national population-based survey. Health Place 2009, 15(3):712-720.
18. Cook T.D. "Waiting for life to arrive": a history of the regression-discontinuity design in psychology, statistics and economics. J. Econ. 2008, 142(2):636-654.
19. Corno L., de Walque D. Socioeconomic determinants of stigmatization and HIV testing in Lesotho. AIDS Care 2013, 25(Suppl. 1):S108-S113.
20. De Neve J.-W., Fink G., Subramanian S.V., Moyo S., Bor J. Length of secondary schooling and risk of HIV infection in Botswana: evidence from a natural experiment. Lancet Glob. Health 2015, 3(8):e470-e477. 10.1016/S2214-109X(15)00087-X.
21. de Walque D., Nakiyingi-Miiro J.S., Busingye J., Whitworth J.A. Changing association between schooling levels and HIV-1 infection over 11 years in a rural population cohort in south-west Uganda. Trop. Med. Int. Health 2005, 10(10):993-1001.
22. Deininger K. Does cost of schooling affect enrollment by the poor? Universal primary education in Uganda. Econ. Educ. Rev. 2003, 22(3):291-305.
23. Delavande A., Sampaio M., Sood N. HIV-related social intolerance and risky sexual behavior in a high HIV prevalence environment. Soc. Sci. Med. 2014, 111:84-93.
24. Dupas P. Do teenagers respond to HIV risk information? Evidence from a field experiment in Kenya. Am. Econ. J. Appl. Econ. 2011, 3(1):1-34.
25. Fife B.L., Wright E.R. The dimensionality of stigma: a comparison of its impact on the self of persons with HIV/AIDS and cancer. J. Health Soc. Behav. 2000, 41(1):50-67.
26. Filmer D., Pritchett L.H. Estimating wealth effects without expenditure data - or tears: an application to educational enrollments in states of India. Demography 2001, 38(1):115-132.
27. Froot K.A. Consistent covariance matrix estimation with cross-sectional dependence and heteroskedasticity in financial data. J. Financ. Quant. Anal. 1989, 24(3):333-355.
28. Genberg B.L., Hlavka Z., Konda K.A., Maman S., Chariyalertsak S., Chingono A., et al. A comparison of HIV/AIDS-related stigma in four countries: negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS. Soc. Sci. Med. 2009, 68(12):2279-2287.
29. Girma E., Gebretsadik L.A., Kaufman M.R., Rimal R.N., Morankar S.N., Limaye R.J. Stigma against people with HIV/AIDS in rural Ethiopia, 2005 to 2011: signs and predictors of improvement. AIDS Behav. 2014, 18(6):1046-1053.
30. Goldman D.P., Smith J.P. Can patient self-management help explain the SES health gradient?. Proc. Natl. Acad. Sci. U. S. A. 2002, 99(16):10929-10934.
31. Govindasamy D., Ford N., Kranzer K. Risk factors, barriers and facilitators for linkage to antiretroviral therapy care: a systematic review. AIDS 2012, 26(16):2059-2067.
32. Greenland S. Interpretation and choice of effect measures in epidemiologic analyses. Am. J. Epidemiol. 1987, 125(5):761-768.
33. Grogan L. Universal primary education and school entry in Uganda. J. Afr. Econ. 2008, 18(2):183-211.
34. Gummerson E. Have the educated changed HIV risk behaviours more in Africa?. Afr. J. AIDS Res. 2013, 12(3):161-172.
35. Gummerson E., Maughan-Brown B., Venkataramani A. Who is taking up voluntary medical male circumcision? Early evidence from Tanzania. AIDS 2013, 27(16):2657-2659.
36. Hargreaves J.R., Bonell C.P., Boler T., Boccia D., Birdthistle I., Fletcher A., et al. Systematic review exploring time trends in the association between educational attainment and risk of HIV infection in sub-Saharan Africa. AIDS 2008, 22(3):403-414.
37. Hargreaves J.R., Glynn J.R. Educational attainment and HIV-1 infection in developing countries: a systematic review. Trop. Med. Int. Health 2002, 7(6):489-498.
38. Hargreaves J.R., Morison L.A., Kim J.C., Bonell C.P., Porter J.D., Watts C., et al. The association between school attendance, HIV infection and sexual behaviour among young people in rural South Africa. J. Epidemiol. Community Health 2008, 62(2):113-119.
39. Herek G.M., Capitanio J.P., Widaman K.F. HIV-related stigma and knowledge in the United States: prevalence and trends, 1991-1999. Am. J. Public Health 2002, 92(3):371-377.
40. Horrace W.C., Oaxaca R.L. Results on the bias and inconsistency of ordinary least squares for the linear probability model. Econ. Lett. 2006, 90(3):321-327.
41. Hutchinson P.L., Mahlalela X. Utilization of voluntary counseling and testing services in the Eastern Cape, South Africa. AIDS Care 2006, 18(5):446-455.
42. Hyman H.H., Sheatsley P.B. Attitudes toward desegregation. Sci. Am. 1964, 211(1):16-23.
43. Imbens G.W., Angrist J.D. Identification and estimation of local average treatment effects. Econometrica 1994, 62(2):467-475.
44. Imbens G.W., Rubin D.B. Bayesian inference for causal effects in randomized experiments with noncompliance. Ann. Stat. 1997, 25(1):305-327.
45. Kalichman S.C., Simbayi L.C. HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa. Sex. Transm. Infect. 2003, 79(6):442-447.
46. Kalichman S.C., Simbayi L.C., Jooste S., Toefy Y., Cain D., Cherry C., Kagee A. Development of a brief scale to measure AIDS-related stigma in South Africa. AIDS Behav. 2005, 9(2):135-143.
47. Katz I.T., Ryu A.E., Onuegbu A.G., Psaros C., Weiser S.D., Bangsberg D.R., Tsai A.C. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. J. Int. AIDS Soc. 2013, 16(Suppl. 2):18640.
48. Kelly, J.D., Weiser, S.D., Tsai, A.C. Proximate context of HIV stigma and its association with HIV testing in Sierra Leone: a population-based study. AIDS Behav. Epub 15 Mar 2015,. http://dx.doi.org/10.1007/s10461-015-1035-9.
49. Kling J.R., Liebman J.B., Katz L.F. Experimental analysis of neighborhood effects. Econometrica 2007, 75(1):83-119.
50. Knoke D., Isaac L. Quality of higher education and sociopolitical attitudes. Soc. Forces 1976, 54(3):524-529.
51. Koku E.F. Desire for, and uptake of HIV tests by Ghanaian women: the relevance of community level stigma. J. Community Health 2011, 36(2):289-299.
52. Lee D.S. Randomized experiments from non-random selection in U.S. House elections. J. Econ. 2008, 142(2):675-697.
53. Lee D.S., Lemieux T. Regression discontinuity designs in economics. J. Econ. Lit. 2010, 48(2):281-355.
54. Leta T.H., Sandoy I.F., Fylkesnes K. Factors affecting voluntary HIV counselling and testing among men in Ethiopia: a cross-sectional survey. BMC Public Health 2012, 12:438.
55. Link B.G. Understanding labeling effects in the area of mental disorders: an assessment of the effects of expectations of rejection. Am. Sociol. Rev. 1987, 52(1):96-112.
56. Link B.G., Cullen F.T., Frank J., Wozniak J.F. The social rejection of former mental patients: understanding why labels matter. Am. J. Sociol. 1987, 92(6):1461-1500.
57. Link B.G., Cullen F.T., Struening E., Shrout P.E. A modified labeling theory approach to mental disorders: an empirical assessment. Am. Sociol. Rev. 1989, 54(3):400-423.
58. Loftus J. America's liberalization in attitudes toward homosexuality, 1973 to 1998. Am. Sociol. Rev. 2001, 66(5):762-782.
59. Ludwig J., Miller D.L. Does head start improve children's life changes? Evidence from a regression discontinuity design. Q. J. Econ. 2007, 122(1):159-208.
60. Maman S., Abler L., Parker L., Lane T., Chirowodza A., Ntogwisangu J., et al. A comparison of HIV stigma and discrimination in five international sites: the influence of care and treatment resources in high prevalence settings. Soc. Sci. Med. 2009, 68(12):2271-2278.
61. Maughan-Brown B. Stigma rises despite antiretroviral roll-out: a longitudinal analysis in South Africa. Soc. Sci. Med. 2010, 70(3):368-374.
62. MEASURE DHS, ICF International Standard Recode Manual for DHS 6 2013, MEASURE DHS/ICF International, Calverton.
63. Mishra V., Agrawal P., Alva S., Gu Y., Wang S. Changes in HIV-related Knowledge and Behaviors in Sub-Saharan Africa 2009, DHS Comparative Reports No. 24, ICF Macro, Calverton.
64. Montez J.K., Friedman E.M. Educational attainment and adult health: under what conditions is the association causal?. Soc. Sci. Med. 2015, 127:1-7.
65. Moscoe E., Bor J., Barnighausen T. Regression discontinuity designs are underutilized in medicine, epidemiology, and public health: a review of current and best practice. J. Clin. Epidemiol. 2015, 68(2):122-133.
66. Murray M.P. Avoiding invalid instruments and coping with weak instruments. J. Econ. Perspect. 2006, 20(4):111-132.
67. Nishimura M., Yamano T., Sasaoka Y. Impacts of the universal primary education policy on educational attainment and private costs in rural Uganda. Int. J. Educ. Dev. 2008, 28(2):161-175.
68. Nyblade L., MacQuarrie K., Phillip F., Kwesigabo G., Mbwambo J., Ndega J., et al. Measuring HIV Stigma: Results of a Field Test in Tanzania 2005, U.S. Agency for International Development, Washington, D.C.
69. Nyblade L., Pande R., Mathur S., MacQuarrie K., Kidd R., Banteyerga H., et al. Disentangling HIV and AIDS Stigma in Ethiopia, Tanzania, and Zambia 2003, International Center for Research on Women, Washington, D.C.
70. Phelan J.C., Link B.G., Tehranifar P. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J. Health Soc. Behav. 2010, 51(Suppl. l):S28-S40.
71. Pitpitan E.V., Kalichman S.C., Eaton L.A., Cain D., Sikkema K.J., Skinner D., et al. AIDS-related stigma, HIV testing, and transmission risk among patrons of informal drinking places in Cape Town, South Africa. Ann. Behav. Med. 2012, 43(3):362-371.
72. Prothro J.W., Grigg C.M. Fundamental principles of democracy: bases of agreement and disagreement. J. Polit. 1960, 22(2):276-294.
73. Pryor J.B., Reeder G.D., Vinacco R., Kott T.L. The instrumental and symbolic functions of attitudes towards persons with AIDS. J. Appl. Soc. Psychol. 1989, 19(5):377-404.
74. Quinley H.E., Glock C.Y. Anti-semitism in America 1979, The Free Press, New York.
75. Rogers W.H. Regression standard errors in clustered samples. Stata Tech. Bull. 1993, 13:19-23.
76. Rosenfield G. The polls: attitudes toward American Jews. Public Opin. Q. 1982, 46(3):431-443.
77. Roura M., Urassa M., Busza J., Mbata D., Wringe A., Zaba B. Scaling up stigma? The effects of antiretroviral roll-out on stigma and HIV testing. Early evidence from rural Tanzania. Sex. Transm. Infect. 2009, 85(4):308-312.
78. Rozin P., Markwith M., Nemeroff C. Magical contagion beliefs and fear of AIDS. J. Appl. Soc. Psychol. 1992, 22(14):1081-1092.
79. Sambisa W., Curtis S., Mishra V. AIDS stigma as an obstacle to uptake of HIV testing: evidence from a Zimbabwean national population-based survey. AIDS Care 2010, 22(2):170-186.
80. Scambler G., Hopkins A. Being epileptic: coming to terms with stigma. Sociol. Health Illn. 1986, 8(1):26-43.
81. Sengupta S., Banks B., Jonas D., Miles M.S., Smith G.C. HIV interventions to reduce HIV/AIDS stigma: a systematic review. AIDS Behav. 2011, 15(6):1075-1087.
82. Sikkema K.J., Watt M.H., Drabkin A.S., Meade C.S., Hansen N.B., Pence B.W. Mental health treatment to reduce HIV transmission risk behavior: a positive prevention model. AIDS Behav. 2010, 14(2):252-262.
83. Simbayi L.C., Kalichman S., Strebel A., Cloete A., Henda N., Mqeketo A. Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa. Soc. Sci. Med. 2007, 64(9):1823-1831.
84. Stangl A.L., Lloyd J.K., Brady L.M., Holland C.E., Baral S. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come?. J. Int. AIDS Soc. 2013, 16(3 Suppl. 2):18734.
85. Stephenson R. Community factors shaping HIV-related stigma among young people in three African countries. AIDS Care 2009, 21(4):403-410.
86. Steward W.T., Herek G.M., Ramakrishna J., Bharat S., Chandy S., Wrubel J., et al. HIV-related stigma: adapting a theoretical framework for use in India. Soc. Sci. Med. 2008, 67(8):1225-1235.
87. Stock J.H., Wright J.H., Yogo M. A survey of weak instruments and weak identification in generalized method of moments. J. Bus. Econ. Stat. 2002, 20(4):518-529.
88. Takada S., Weiser S.D., Kumbakumba E., Muzoora C., Martin J.N., Hunt P.W., et al. The dynamic relationship between social support and HIV stigma in rural Uganda. Ann. Behav. Med. 2014, 48(1):26-37.
89. Thistlethwaite D.L., Campbell D.T. Regression-discontinuity analysis: an alternative to the ex post facto experiment. J. Educ. Psychol. 1960, 51(6):309-317.
90. Tsai A.C. Reliability and validity of depression assessment among persons with HIV in sub-Saharan Africa: systematic review and meta-analysis. J. Acquir. Immune Defic. Syndr. 2014, 66(5):503-511.
91. Tsai A.C. Socioeconomic gradients in internalized stigma among 4,314 persons with HIV in sub-Saharan Africa. AIDS Behav. 2015, 19(2):270-282.
92. Tsai A.C., Bangsberg D.R., Frongillo E.A., Hunt P.W., Muzoora C., Martin J.N., Weiser S.D. Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda. Soc. Sci. Med. 2012, 74(12):2012-2019.
93. Tsai A.C., Bangsberg D.R., Weiser S.D. Harnessing poverty alleviation to reduce the stigma of HIV in sub-Saharan Africa. Public Libr. Sci. Med. 2013, 10(11):e1001557.
94. Tsai A.C., Karasic D.H., Hammer G.P., Charlebois E.D., Ragland K., Moss A.R., et al. Directly observed antidepressant medication treatment and HIV outcomes among homeless and marginally housed HIV-positive adults: a randomized controlled trial. Am. J. Public Health 2013, 103(2):308-315.
95. Tsai A.C., Weiser S.D., Petersen M.L., Ragland K., Kushel M.B., Bangsberg D.R. A marginal structural model to estimate the causal effect of antidepressant medication treatment on viral suppression among homeless and marginally housed persons with HIV. Arch. General Psychiatry 2010, 67(12):1282-1290.
96. Turan J.M., Hatcher A.H., Medema-Wijnveen J., Onono M., Miller S., Bukusi E.A., et al. The role of HIV-related stigma in utilization of skilled childbirth services in rural Kenya: a prospective mixed-methods study. Public Libr. Sci. Med. 2012, 9(8):e1001295.
97. Uganda Bureau of Statistics, ICF International Inc Uganda Demographic and Health Survey 2011 2012, Uganda Bureau of Statistics and Calverton: ICF International, Inc, Kampala.
98. Uganda Ministry of Health Uganda AIDS Indicator Survey 2011 2012, Uganda Ministry of Health and Calverton: ICF International, Kampala.
99. UNAIDS National AIDS Programmes: a Guide to Monitoring and Evaluation 2000, UNAIDS/00.17E, Joint United Nations Programme on HIV/AIDS, Geneva.
100. Visser M.J., Kershaw T., Makin J.D., Forsyth B.W. Development of parallel scales to measure HIV-related stigma. AIDS Behav. 2008, 12(5):759-771.
101. Weil F.D. The variable effects of education on liberal attitudes: a comparative-historical analysis of anti-semitism using public opinion survey data. Am. Sociol. Rev. 1985, 50(4):458-474.
102. Weiser S.D., Heisler M., Leiter K., Percy-de Korte F., Tlou S., DeMonner S., et al. Routine HIV testing in Botswana: a population-based study on attitudes, practices, and human rights concerns. Public Libr. Sci. Med. 2006, 3(7):e261.
103. Williams R.L. A note on robust variance estimation for cluster-correlated data. Biometrics 2000, 56(2):645-646.
104. Wolfe W.R., Weiser S.D., Leiter K., Steward W.T., Percy-de Korte F., Phaladze N., et al. The impact of universal access to antiretroviral therapy on HIV stigma in Botswana. Am. J. Public Health 2008, 98(10):1865-1871.
105. Wooldridge J.M. Econometric Analysis of Cross Section and Panel Data 2002, MIT Press, Cambridge, Massachusetts.
106. Yoder P.S., Nyblade L. Comprehension of Questions in the Tanzania AIDS Indicator Survey 2004, ORC Macro, Calverton.