Investigating communication strategies of HIV discordant couples in Africa

描述（由申请人提供）：拟议的研究重点是两个非洲国家（卢旺达和赞比亚）的艾滋病毒感染高危人群，即艾滋病毒不和谐夫妇（一方为艾滋病毒阳性，另一方为艾滋病毒阴性）。研究表明，夫妇自愿咨询和检测（CVCT）在减少艾滋病毒传播给阴性伴侣方面非常成功，但研究还表明，一旦夫妇意识到他们的血清不一致状态并接受艾滋病毒预防咨询，并非所有夫妇都能够正确和/或持续使用现有避孕套，以防止传播给阴性伴侣。本研究旨在调查行为障碍（个人，夫妻和社会文化），阻止长期关系中一致和正确使用避孕套，以及如何克服这些障碍。拟议研究的结果将促进我们对可持续降低风险的理解，并指导制定文化上适当的干预措施，以针对被确定为不一致使用避孕套的夫妇。与赞比亚卢萨卡和卢旺达基加利这两个世界上最大的艾滋病毒不和谐研究地点合作，本研究建立在申请人进行的初步定量和定性研究的基础上；艾滋病风险降低咨询信息的细化和干预措施的制定；以生物医学基础设施为基础，引入以行为为重点的方法的潜力，这些方法也可能有助于更有效地利用和获得保健服务以及政策变化；并支持NIMH艾滋病、健康和行为研究部门的目标，即使用行为方法将研究转化为干预措施，以减少艾滋病毒风险行为和疾病负担。根据初步调查结果，编制了一份定量问卷，将分发给两个研究地点随机选择的330对夫妇（N=660）。夫妇在每个站点的选择将平均分配给两种艾滋病毒血清不一致的夫妇（男性阳性/女性阴性和男性阴性/女性阳性）。分析将包括描述性统计，丈夫和妻子的反应之间的协议的一致性，和层次线性模型。

DESCRIPTION (provided by applicant): The proposed research focuses on a largely high risk yet understudied population for HIV infection in two African countries (Rwanda and Zambia), namely HIV discordant couples (when one partner is HIV positive and the other is HIV negative). Research shows that couples' voluntary counseling and testing (CVCT) has been highly successful at reducing HIV transmission to the negative partner, yet research also shows that once couples are aware of their serodiscordant status and receive counseling on HIV prevention, not all couples are able to use the available condoms correctly and/or consistently enough to prevent transmission to the negative partner. This study seeks to investigate the behavioral barriers (individual, couple, and socio-cultural) that prevent consistent and correct condom use within long-term relationships and how these barriers can be overcome. Findings from the proposed research will advance our understanding of sustainable risk reduction and guide the development of a culturally appropriate intervention to target couples identified as inconsistent condom users. Collaborating with the two largest HIV discordant research sites in the world in Lusaka, Zambia, and Kigali, Rwanda, this study builds upon preliminary quantitative and qualitative studies conducted by the applicant; aids in the refinement of risk reduction counseling messages and intervention development; builds upon a biomedical infrastructure that introduces the potential of behavioral focused approaches that also may contribute to more effective health care utilization and access and policy changes; and supports the NIMH Division of AIDS and Health and Behavior Research goals to use behavioral approaches to translate research into interventions to reduce HIV risk behaviors and disease burden. Based upon preliminary findings, a quantitative questionnaire has been developed and will be disseminated to 330 randomly selected couples at each of the two research sites (N=660). Couples' selection at each site will be equally split between the two types of HIV serodiscordant couples (male positive/female negative and male negative/female positive). Analyses will include descriptive statistics, concordance of agreement between husbands and wives' responses, and hierarchical linear modeling. PUBLIC HEALTH RELEVANCE: With the global call for HIV serostatus knowledge and the expansion of voluntary counseling and testing to help curb the HIV epidemic, there is a crucial need for the investigation and understanding of behavioral factors that prevent consistent and correct condom use among couples in which one partner is HIV positive. A greater understanding of factors that disrupt condom use among long-term users is the critical next step in the development of HIV prevention and intervention.