When we talk about HIV prevention, we tend to frame it as a medical challenge and of course it is one. To accelerate the progress in the AIDS response we must reduce transmission and people's exposure to the virus. We need to develop affordable vaccines and microbicides that will make exposure less dangerous. We also need to make sure people living with HIV have access to treatment.
But ending AIDS is as much a social challenge as a clinical one. One of the clearest lessons of the past three decades is that illiteracy and poverty fuel the spread of HIV and that education can slow it. Education -- not just sex education but literacy, numeracy, critical-thinking and global citizenship -- is the social equivalent of a vaccine, and it's already available for clinical use.
That's why I and other health advocates so strongly support Education First, United Nations Secretary-General Ban Ki-moon's new effort to expand and improve schooling around the world. To assist in these efforts, the Secretary-General has appointed the first ever Special Envoy on Global Education, former UK Prime Minister Gordon Brown. Education First could open new pathways to peace, economic development and environmental sustainability. It also embodies our best hope yet of empowering young people, especially girls, for an AIDS-free generation. Our challenge is to seize the opportunity it presents.
How does education protect youth from HIV? At the most basic level, it gives them the knowledge and skills to avoid risky behavior. Those who receive comprehensive sex education are less likely to become sexually active at early ages and more likely to protect themselves when they do start having sex. Research from Nigeria suggests that even a modest investment in sexuality education (roughly U.S. $7 per student in that country) can yield lifelong health benefits while reducing the medical costs associated with unintended pregnancy, HIV and other sexually transmitted infections.
But sex education is only part of the story. General education helps counter gender inequality, thus reducing girls' vulnerability to HIV by bolstering their self-esteem, assertiveness and economic prospects. Partly because they depend less on men for food, housing and other basic necessities, educated women are better equipped to resist violence and sexual exploitation. In sub-Saharan Africa, girls who attend primary school are less likely than those that do not to contract HIV, and secondary education further increases their advantage. In Tanzania, young women who complete high school have only one-fourth the infection rate of those who do not attend any school.
Education can also help the millions of young women already living with HIV in low- and middle-income countries. In Malawi, 60 percent of high school-educated mothers know that a brief treatment regimen can keep an HIV-positive woman from passing the virus to her child during birth. Yet only 27 percent of women with no education are aware of this -- a critical gap when you consider that globally more than a quarter of a million babies were infected with HIV during 2011 alone.
The world has made immense progress since the year 2000, when 189 countries signed the groundbreaking Millennium Development Goals. Among other pledges, the signatories committed themselves to achieving universal primary education and to reversing the spread of HIV within 15 years. By 2010, the enrollment rate for children of primary school age had risen from 82 percent to 90 percent and the number of out-of-school children had fallen from 108 million to 61 million worldwide. During the same period, HIV infection rates amongst young people declined significantly. In low- and middle-income countries, the expansion of treatment added some 14 million years to the lives of people living with HIV.
But where education is concerned, our progress has not gone far enough and our promises to children are still unmet. In sub-Saharan Africa, nearly a fourth of all school-age children are still not enrolled, and the proportion is closer to a third among girls. What is more, over one third of girls who enroll in primary school do not complete it. If current trends continue, we may have more out-of-school children in 2015 than we have today. And for millions of young women -- especially women marginalized by poverty or disability -- the consequences will include exploitation and ill health.
Education First is the blueprint for a brighter future, but it won't succeed without steadfast commitment from all sectors of society, including governments and funders as well as students and families. And success will require resources as well as good will. We now have an historic opportunity to end one of the greatest threats to humanity of our lifetime. Ending AIDS is possible -- and education is the key to success.
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