Changes over time in sexual behaviour among young people with different levels of educational attainment in Tanzania

Hargreaves, J; Slaymaker, E; Fearon, E; Howe, LD Journal of the International AIDS Society , 2012; 15(1):17363

Patterns of behaviour suggest that differences in HIV incidence might explain trends in HIV prevalence among different educational groups in Tanzania.  

This paper analyses data from two large nationally representative surveys conducted in Tanzania in 2003/2004 and 2007/2008. Focusing on young people aged 15 to 24 years, it reports on the following variables: 

  • first sex experiences
  • having more than one sexual partner in the last year
  • unprotected last sex with a non-cohabiting partner

It explores whether the behaviours differed by educational attainment in 2003/2004 and in 2007/2008 and whether changes over time in these behaviours differed between educational groups.

Inverse equity

The authors discuss the extent to which these and other differences can be explained by the inverse equity hypothesis.


The 'inverse equity hypothesis’ … describes the phenomenon that health needs are often inversely associated with the quality and accessibility of health care services. The inverse equity hypothesis suggests that the introduction of health interventions will tend to benefit those of the highest socioeconomic position first, only later benefiting those in lower socioeconomic groups.

They argue that these and other findings are consistent with the hypothesis, but that more evidence is needed before definitive conclusions can be reached.



  • The rate of first sex was lower among more educated males in 2007/2008 but not in 2003/2004, and among females in both surveys.
  • The change over time in educational patterning of the rate of first sex in males was mostly due to a declining rate among the secondary educated groups.
  • Among males, having had more than one sexual partner in the last year was associated with lower education in 2003/2004 and in 2007/2008.
  • Among females, those with less education were more likely to report more than one partner in 2003/2004, although by 2007/2008 there was little association between education and reporting more than one partner.
  • Unprotected last sex with a non-cohabiting partner was less common among the more educated.
  • Among both sexes this decreased over time among those with no education and increased among those with secondary education.

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