Stoner, M.C.DNeilands, T.BKahn, KHughes, J.PGómez-Olivé, F.XTwine, RTollman, SLaeyendecker, OMacPhail, CAhern, JLippman, S.APettifor, A2024-08-112024-08-112019-12Stoner MCD, Neilands TB, Kahn K, Hughes JP, Gómez-Olivé FX, Twine R, Tollman S, Laeyendecker O, MacPhail C, Ahern J, Lippman SA, Pettifor A. Multilevel Measures of Education and Pathways to Incident Herpes Simplex Virus Type 2 in Adolescent Girls and Young Women in South Africa. J Adolesc Health. 2019 Dec;65(6):723-729. doi: 10.1016/j.jadohealth.2019.06.008.https://doi.org/10.1016/j.jadohealth.2019.06.008https://pubmed.ncbi.nlm.nih.gov/31521513/https://hdl.handle.net/11288/597159Purpose: Schooling is associated with a lower risk of Herpes simplex virus type 2 (HSV-2) in adolescent girls and young women, but there is little understanding of the pathways underlying this relationship. Methods: We used data from adolescent girls and young women in South Africa enrolled in the HIV Prevention Trials Network 068 study. We tested a structural equation model where individual household and community education measures were associated directly and indirectly with incident HSV-2 through HIV knowledge, future aspirations, age-disparate partnerships, sex in the last 12 months, and condomless sex. Results: Community, household, and individual measures of schooling were all associated with incident HSV-2 infection through mediated pathways that increased the likelihood of having sex. Low school attendance (<80% of school days) increased the likelihood of having sex through increased age-disparate partnerships and reduced future aspirations. Fewer community years of education increased the likelihood of having sex through increased age-disparate partnerships. Parental education level was indirectly associated with HSV-2 overall, although we could not identify the individual pathways that were responsible for this association. Conclusions: Community and individual schooling interventions may reduce the risk of HSV-2 infection by influencing the likelihood of having sex, partner age, and future aspirations.enAttribution 3.0 United Stateshttp://creativecommons.org/licenses/by/3.0/us/Adolescent girls and young womenEducationHSV-2MediationSexual behaviorsMultilevelHIV preventionArticleJournal of Adolescent Health