Gender disempowerment, condom use, and HIV transmission among female sex workers in Salvador, Brazil

Program/Project Purpose: The educational achievements of women are related to reduced fertility and improved education and health outcomes for their children, including survival rate, cognitive function and education levels.Therefore, the failure of women to achieve high education levels is an important factor in the intergenerational transmission of poverty.The Ghana Health and Education Initiative's (GHEI) education sector aims to improve the educational outcomes and opportunities of children, with an emphasis on girls, in a large rural village in Ghana, and has greatly expanded between 2004-2014.Structure/Method/Design: GHEI's education programs include a scholarship program, girls' empowerment camp and intensive supplemental education programs for both well performing junior high school (JHS) students.Some programs are focused on a few well-performing students while others are focused on students in the entire community.The community's involvement and ownership is essential and integrated throughout.Our primary outcome measure is performance on a standardizednational examination taken after JHS called the Basic Education Certificate Examination (BECE).Students must pass this test to be admitted to senior high school, and students who achieve a high pass are more likely to be admitted.Records of BECE scores for Humjibre JHS, Bibiani-Anhwiaso-Bekwai District were obtained from the Bibiani District Administration.Data was analyzed using STATA v.10. Outcomes & Evaluation:The percent of girls passing the BECE examination in the intervention area increased from 4% in 2001 to 100% in 2013 (p < 0.05), and has remained at 100% for the last 5 years.The district girls' scores improved from 33% in 2001 to 94% in 2013 (p < 0.001).High pass scores for girls increased from 1.1% in 2001 to 10.1% (p < 0.01%), a ten-fold increase, in the cumulative years 2012-2013 in the intervention area, versus an increase from 10.6% to 22% in the district over the same time period (p < 0.0001), roughly a two-fold increase.Going Forward: These results demonstrate the potential for dramatic improvement in educational outcomes for girls in rural Ghana at a relatively low cost of $7.94 per child per year.Over the past decade, girls from the intervention area now pass the BECE as often as girls in the district.We have seen a large improvement in high pass achievement relative to the district girls (ten-fold vs. two fold increase), but still fewer girls in our village achieve high pass.Ongoing challenges include funding high quality services at a low cost in a low resource environment, expanding our reach to all girls students, and parental and community support for girl students.Looking forward, we plan to continue the support of students in our intensive supplemental program, while working to support and reach more girls in the general community.

Abstract licence: CC BY-NC-ND

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