De Neve, J-W., Fink, G., Subramanian, S.V., and Bor, J. The Lancet Global Health (June 2015), doi: 10.1016/S2214109X(15)00087-X.
In 1996, Botswana reformed the grade structure of secondary schools, expanding access to grade 10 and increasing educational attainment for affected cohorts (those who entered secondary school in 1996 or later). Using HIV biomarkers and demographics for 3,965 women and 3,053 men from two nationally representative surveys (2004 and 2008), the authors examined the effect of education on the cumulative risk of HIV infection and assessed the cost-effectiveness of secondary schooling as an HIV prevention intervention. Analysis showed that secondary schooling had a large protective effect against risk of HIV infection in Botswana, with particularly large impacts among women. Moreover, each additional year of secondary schooling caused by the policy change led to a reduction in the cumulative risk of HIV infection (by 8.1 percentage points), relative to a baseline prevalence of 25.5 percent in the pre-reform cohort. The authors also reported that secondary school was cost-effective as an HIV prevention intervention, based on standard metrics (cost per HIV infection averted was US$27,753). They concluded that investment in expanded access to secondary schooling is an effective HIV preventive measure and should be included in combination HIV prevention strategies in countries with large, generalized HIV epidemics.