Secondary schooling might be as good an HIV investment as male circumcision

Remme, M; Watts, C; Heise, L; Vassall, A The Lancet, 2015;

Jan-Walter De Neve and colleagues provide compelling evidence of a causal relation between secondary education and HIV incidence, showing that a policy change in Botswana led to 0.792 additional years of secondary schooling, with each added year reducing HIV risk by 8 percentage points. The estimated cost per HIV infection averted was US$27,753. De Neve and colleagues thus conclude that secondary schooling is similarly cost effective for HIV prevention as pre-exposure prophylaxis, but is more expensive than male circumcision.

In this article, Remme et al argue that secondary education is a sound economic investment in its own right, but remains resource-constrained in many low-income and middle-income countries. Therefore, the relevant question is what level of co-investment in education from HIV budgets could be justified, in view of the benefits against HIV?

They state that if the parties interested in HIV prevention contributed to educational funding up to the value of their next best investment (in this case, male circumcision), further schooling expansion could be achieved. With the threshold of $1,096 per infection averted, these researchers show that HIV budgets could contribute up to 4% of total costs for an additional year of secondary schooling. 

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