EXPLORING INTENTIONAL CHILDBEARING AND HIV RISK AMONG MEN & WOMEN WITH HIV/AIDS

描述（由申请人提供）：由于HIV感染在美国被视为一种慢性疾病而非致命疾病，感染HIV的双性恋和异性恋男性和女性越来越多地承认他们想要孩子。这构成了具有挑战性的公共卫生问题。试图要孩子可能会增加艾滋病毒传播给那些在试图怀孕时不使用避孕套的性伴侣。此外，感染艾滋病毒的孕妇有将艾滋病毒传染给胎儿的风险。虽然一些感染艾滋病毒的男性和女性寻求生殖医疗援助，以减少艾滋病毒传播给伴侣的风险，但这些服务在美国基本上仍然无法获得；此外，他们的艾滋病毒状况可能会限制他们收养儿童。尽管存在这些公共卫生问题，但很少有研究审查了感染艾滋病毒的男女的生殖决策过程、有意生育的心理社会经验和艾滋病毒性冒险行为。拟议的研究将从40名艾滋病毒阳性的双性恋和异性恋男性和女性样本中获得深入的访谈数据，这些人在艾滋病毒诊断后计划怀孕（故意生育），其中20人怀孕，其中20人未成功怀孕。参与者将接受私下采访，以记录他们有意生育的经历，包括使用的受孕策略类型、使用频率、他们对艾滋病毒传播的了解、他们如何决定要孩子、他们是否从事无保护性交以怀孕孩子，以及这些经历如何影响他们的日常活动。本研究的具体目的是：1)描述异性恋和双性恋艾滋病毒感染者有意生育决策的社会心理因素和经验；2)建立生殖决策过程如何影响艾滋病毒横向传播行为风险的理论模型。数据将使用基础理论技术进行分析，这是一个联合收集、编码和分析数据的过程，允许出现基本的社会结构过程和现象的含义。该项目将产生初步数据，作为R01提案的基础，以在更广泛的美国艾滋病毒感染者人群中测试新兴理论模型。这项研究还将为艾滋病毒服务和护理提供者提供实用的见解，了解感染艾滋病毒的男女如何在不损害自己或其伴侣和子女健康的情况下，在决定生育时应对道德和心理压力。最后，这项研究将帮助公共卫生工作者通过制定适当的艾滋病毒干预措施来提高艾滋病毒预防计划的有效性，这些干预措施将考虑到人们从事艾滋病毒冒险行为的生育动机。

DESCRIPTION (provided by applicant): As HIV infection is managed more as a chronic rather than fatal condition in the U.S., HIV-infected bisexual and heterosexual men and women increasingly acknowledge their intentions to have children. This poses challenging public health concerns. The attempt to have children may increase HIV transmission to sexual partners who do not use condoms when trying to conceive. Additionally, HIV infected women who become pregnant risk HIV transmission to the fetus. Although some HIV-infected men and women seek reproductive medical assistance to reduce HIV transmission risks to partners, these services remain largely inaccessible in the U.S.; furthermore, their HIV status may restrict them from adopting children. Despite these public health concerns, very little research has examined the reproductive decision making processes, psychosocial experiences surrounding intentional childbearing, and HIV sexual risk taking behaviors of HIV- infected men and women. The proposed research will obtain in-depth interview data from a sample of 40 HIV positive bisexual and heterosexual men and women who have, after HIV diagnosis, planned pregnancies (intentional childbearing), 20 of whom have achieved pregnancies and 20 of whom have been unsuccessful in achieving pregnancy. Participants will be privately interviewed to document their intentional childbearing experiences including the types of conception strategies used, frequency of use, what they know about HIV transmission, how they make decisions to have a child, whether they have engaged in unprotected intercourse to conceive a child, and how these experiences impact their day-to-day activities. The specific aims of this study are to: 1) Describe the psychosocial antecedents and experiences of intentional childbearing decisions among heterosexual and bisexual HIV-infected men and women, and to 2) Develop a theoretical model of how reproductive decision making processes influence the behavioral risk of horizontal HIV transmission. Data will be analyzed using grounded theory techniques, a process of joint collection, coding, and analysis of the data that allows for the basic social structural processes and meaning of a phenomenon to emerge. This project will generate preliminary data that can serve as the foundation for a R01 proposal to test the emergent theoretical model in a broader U.S. population of HIV-infected men and women. The study will also offer practical insights for HIV service and care providers of how HIV-infected men and women navigate the ethical and psychological strains around the decision to have children without harming the health of themselves or their partners and children. Finally, this study will help public health workers improve the effectiveness of HIV prevention programs by developing appropriate HIV interventions that take into account people's fertility motivations for engaging in HIV risk-taking behaviors.