Social Determinants of Health: Is Educational Attainment Associated with Condom Use and Sexual Partnerships in Swaziland?

There is a need for epidemiological studies to investigate the social determinants of HIV/AIDS-related sexual behaviors in Sub-Saharan Africa. Using data from the 2006-2007 Swaziland Demographic and Health Surveys, we examined the associations between educational attainment and condom use at high-risk sexual intercourse and sexual partnerships among adults aged 15-54 in Swaziland. We fit multivariate logistic regression models to obtain odds ratios with 95% confidence intervals to test the hypothesis that higher educational attainment was associated with higher condom use. Our findings showed that the odds of condom use at high-risk sexual intercourse in the population increased at each level of educational attainment above elementary education. Condom use remained positively and significantly associated with incomplete secondary education, complete secondary education, and higher education. No association was found between single sexual partnerships and educational attainment. Sexual monogamy was significantly associated with age, place of residence, HIV knowledge, and beliefs but not with educational attainment. Findings from this study will be useful in the design and implementation of multi-sectoral HIV/AIDS interventions and policies especially those that call for increased collaboration among the health and education sector in addressing the HIV/AIDS crisis in Swaziland and similar sub-Saharan African countries.