HIV status and achieving fertility desires: Implications for HIV prevention and t

描述（由申请人提供）：本研究的目的是帮助面临艾滋病毒普遍流行的非洲国家的个人和夫妇实现其家庭规模目标，防止意外怀孕，同时避免或应对艾滋病毒感染。为此，我们建议进行新的研究，以改善性健康和生殖健康服务的提供，包括与艾滋病毒有关的护理。在撒哈拉以南非洲，关于艾滋病毒状况对生育意愿和避孕药具使用影响的研究非常少。现有的研究有重要的局限性：大多数是小规模的，旨在评估干预措施的影响；大多数研究在卫生设施取样的艾滋病毒阳性人群，而且大多数只包括妇女，缺乏男子的观点，这在撒哈拉以南非洲尤其重要。为了实现这项研究的目标，我们提出了三项研究工作：(a)我们将对撒哈拉以南非洲14个国家现有的具有全国代表性的育龄男女调查数据进行新的分析，以提供艾滋病毒状况（基于调查中进行的生物标志物检测）与生育欲望、性行为和生殖行为之间相互关系的区域概况；将对拥有艾滋病毒相关服务可得性信息的5个国家进行双变量和多变量分析，以及多水平分析。(b)为了更深入地了解艾滋病毒状况与对艾滋病毒检测和服务的态度之间的关系以及妇女和男子为实现生育愿望和预防或应对艾滋病毒感染所采取的行动，我们将在一个艾滋病毒中等流行国家（尼日利亚）和一个高流行国家（赞比亚）进行一项分两部分的研究：对每个国家以社区为基础的1300名男女样本和以设施为基础的200名艾滋病毒阳性者样本进行定量调查；并从每个国家的定量调查中系统选择48名受访者进行深入访谈。(c)我们将对每个国家（尼日利亚和赞比亚）提供性健康和生殖健康服务的约80名保健提供者进行半结构化访谈，以便更好地了解提供者在帮助男子和妇女实现生育愿望和避免或应对艾滋病毒感染方面的作用，并特别注意最近例行化和扩大艾滋病毒检测的努力。从公共卫生的角度来看，预防艾滋病毒传播和意外怀孕是撒哈拉以南非洲的高度优先事项，该区域的艾滋病毒流行率和未满足的避孕需求是世界上最高的。艾滋病毒检测和艾滋病毒阳性患者药物治疗的可得性增加，这两种最近的趋势使我们更加迫切需要对艾滋病毒预防、艾滋病毒相关护理和预防意外怀孕之间的关系进行新的研究。拟议的研究将指导面临困难的选择和决定，以满足这些双重需求的提供者。

DESCRIPTION (provided by applicant): The objective of this study is to help individuals and couples in African countries facing generalized HIV epidemics to achieve their family size goals and prevent unintended pregnancies while avoiding or coping with HIV infection. To do so, we propose to undertake new research that will improve provision of sexual and reproductive health services, including HIV- related care. Research on the influence of HIV status on childbearing intentions and contraceptive use in sub-Saharan Africa is very scarce. Existing studies have important limitations: most are small-scale and designed to assess the impact of interventions; most study HIV-positive people, sampled at health facilities, and most include women only, and lack the perspective of men, especially important in sub-Saharan Africa. To meet the study's objective, we propose three research efforts: (a) We will undertake new analyses of existing nationally representative survey data on men and women of reproductive age in 14 countries of sub-Saharan Africa, to provide a regional overview of the interrelationships between HIV status (based on biomarker testing, done in the surveys) and fertility desires and sexual and reproductive behaviors; bivariate and multivariate analyses will be done, as well as multilevel analyses for the 5 countries that also have information on availability of HIV-related services. (b) To provide deeper understanding of relationships between HIV status and attitudes regarding HIV-testing and services and the actions women and men are taking to achieve their fertility aspirations and prevent or cope with HIV infection, we will conduct a two-part study in one moderate-HIV-prevalence country (Nigeria) and one high prevalence country (Zambia): a quantitative survey of a community-based sample of 1300 men and women and a facility-based sample of 200 HIV positive people in each country; and in-depth interviews with 48 respondents systematically selected from the quantitative survey in each country. (c) We will conduct semi-structured interviews with about 80 health care providers in each country (Nigeria and Zambia) that provide sexual and reproductive health care, to improve understanding of the roles of providers in helping men and women meet their fertility aspirations and avoid or cope with HIV infection, with special attention to recent efforts to routinize and expand HIV testing. Project Narrative From the public health perspective, preventing the transmission of HIV and unintended pregnancy are very high priorities in sub-Saharan Africa, a region where HIV prevalence and unmet need for contraception are the highest in the world. Two recent trends} increased availability of HIV testing and of drug treatments for the HIV-positive} add to the urgency of the need for new research on the relationships between HIV prevention, HIV-related care, and prevention of unintended pregnancy. The proposed research will guide providers who face difficult choices and decisions in meeting these dual needs.