far higher than in any other country in the table. Although the magnitude of the change varies, increases over time appear in all countries surveyed. In many countries, condom use is higher among teenagers than among women in their early 20s. This pattern has been interpreted by some as reflecting a greater willingness among those just starting their sexual lives to accept the use of condoms (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2000b). It may also be partially explained by the fact that condom use tends to decline with the duration of relationships (Bankole, Darroch, and Singh, 1999; Norris and Ford, 1999), and young people in their early 20s may be more likely to be involved in long-term relationships.

In contrast to earlier studies, which tended to show higher HIV prevalence among educated individuals, recent studies based on cross-sectional data suggest that this relationship is beginning to disappear or even be reversed (Glynn et al., 2004; Hargreaves and Glynn, 2002). This is probably due to the greater ability of educated people to both access information on HIV prevention and to act on it. There is some recent evidence that more educated people are less likely to engage in various types of risky sexual behavior and more likely to use condoms when they do (Lagarde et al., 2001).⁷ One study using 12 years of longitudinal data from Uganda demonstrates convincingly the evolving relationship between HIV and education (de Walque, 2002). The study found no relationship between education and HIV prevalence among young people (ages 18-29) in the early 1990s. However, 10 years later, HIV prevalence had decreased substantially more among those with secondary school education than among those with no or primary education (Figure 4-4). Based on the available evidence, trends toward improvements in education thus imply progress in the reduction of HIV, but the results of these studies also suggest that HIV/AIDS prevention campaigns may need to be targeted more effectively at those with no or low levels of education.

For young people, particularly for young men, injuries—mostly due to road traffic accidents, violence, war, and suicide—contribute substantially to mortality and morbidity. According to WHO data (World Health Organization, 2001a), injuries (unintentional and intentional combined) in sub-Saharan Africa make up a larger share of all deaths among males ages 15-