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Despite remarkable progress in the fight against HIV, the number of new infections remains unacceptably high, epidemics continue to grow in certain communities, and therefore AIDS continues to be one of the deadliest pandemics of our times.

Previous research identifies two critical ways to address HIV prevention in developing countries:

• educating women
• using mobile phones to improve health literacy and access to virtual healthcare.

A cross-national analysis of Women’s education, mobile phones, and HIV infections in low- and middle-income countries, 1990–2018 analyzes the rate of new HIV infections over almost 30 years in low- and middle-income countries. This study bridges these literatures by evaluating how women’s education and mobile technology work together to support the goals of HIV prevention in low- and middle-income countries.

Education & Mobile Phones Reduce HIV in Women

Using two-way panel fixed effects regression models of HIV incidence across 76 developing countries, we find that both increasing access to women’s education and increasing access to mobile phones are associated with fewer HIV infections over time.

Furthermore, we discover that women’s education moderates the relationship between mobile phones and HIV. More specifically, mobile phones seem to be more beneficial for HIV prevention in cases where rates of formal schooling are low. However, at higher levels of women’s education, the impact of mobile phones on new HIV infections is substantially reduced.

Longitudinal Analysis of Education & Mobile Phones

As women’s education and mobile phone use both escalate over time, HIV incidence declines. Indeed, the expansion of mobile phones toward the end of the time period is quite remarkable.

In 1990, the average of mobile phone subscriptions for the sample is .25%. In 2018, the average grows to 101%. As mobile phones increase across countries, HIV incidence decreases during this time period.  As women’s education increases, HIV incidence decreases.

For a more detailed look at these trends over time, we analyzed HIV incidence, female secondary school enrollment, and mobile phone subscriptions by country. These supplementary figures demonstrate the variation in all three variables over time, further highlighting the necessity of longitudinal analysis.

1. Physician density matters

Only one variable, physicians per 1000, is significantly associated with HIV incidence in the control-only model. The coefficient for physicians is negative, which suggests that an increase in the number of practicing physicians is associated with a decrease in HIV incidence within countries over time.

2. Female education matters

The coefficient for female secondary school enrollment is negative and statistically significant, indicating that as the percentage of educated women in a country increases, HIV incidence decreases over time. The coefficient for physicians per 1000 remains statistically significant, with a negative coefficient indicating that an increase in available physicians in a country is associated with a decrease in HIV incidence over time.

3. Mobile phone adoption matters

We find that the coefficient for mobile penetration is negative and statistically significant. Thus, as the penetration of mobile phones increases across countries this corresponds with a decrease in HIV incidence over time.  The coefficients for women’s education and physicians per 1000 remain negative and statistically significant.

4. Phone adoption by uneducated women matters most

Both mobile penetration and women’s education are associated with declining HIV incidence.  The negative coefficient for mobile phones indicates that as mobile penetration increases, HIV incidence decreases up until 80% of women are enrolled in secondary school. Furthermore, the size of this negative association consistently decreases as the percent of educated women increases from 20% to 80%.

After 80% of women are educated, we find no significant association between mobile phones and HIV incidence. Women’s education moderates the relationship between mobile phones and HIV incidences, so that at lower levels of education, higher mobile phone penetration is associated with the largest decrease in HIV incidence.

In sum, the expansion of female secondary school enrollment and the expansion of mobile phones are both associated with improved population health through the reduction of new HIV infections. However, mobile phones appear to be more impactful for women at lower levels of education, as women benefit from health information and virtual healthcare accessible through phone subscriptions. At higher levels of education, such information is redundant, and therefore mobile phones access is less impactful.

5. Educate women AND increase mobile phone adoption

The results suggest that mobile phones may be an effective HIV intervention and that mHealth programs should continue to be developed and expanded. However, mobile phones do not take the place of formal schooling.

The results also underscore the robust association between women’s education and HIV. Beyond the health benefits, formal education is also related to a host of other benefits for girls (i.e., employment, income, empowerment). Taken together, the analyses do not suggest an “either/or” policy prescription, but rather a “both/and” prescription.

The implication is not that young women should either go to school or have a mobile phone to keep themselves safe from HIV infection. Rather, both formal schooling and mobile phones can potentially be powerful tools to improve health and wellness.

Emerging ICT4D programs should note the findings of this study in developing mHealth initiatives. The most successful programs will not only target demographics with lower access to formal education, but also go beyond technology to emphasize and encourage formal schooling in their programming.

A lightly edited synopsis of A cross-national analysis of Women’s education, mobile phones, and HIV infections in low- and middle-income countries, 1990–2018 by Aarushi Bhandari, Davidson College, and Rebekah Burroway, Stony Brook University