Reproductive health decisions and HIV infection risk

摘要 高流行率地区的成熟艾滋病毒流行的特点是， 稳定的关系，代表着相当大的艾滋病毒传播风险。这一流行病主要影响那些 在生育高峰年，她们可能不知道自己的艾滋病毒状况或使用避孕套。故意 在资源有限的环境中，生育可能使异性夫妇面临感染艾滋病毒的风险， 艾滋病毒高流行地区，社会非常重视生儿育女。 我们提出了一项以社区为基础的前瞻性队列研究，该研究将提供以家庭为基础的艾滋病毒咨询， 对异性恋夫妇进行检测，获得生殖健康和性健康数据， 肯尼亚西部Nyando区男女艾滋病毒感染率一个随机选择的艾滋病毒队列 不一致的（n？960），一致阴性（子集的n？960)一致性阳性（n？480)夫妇将 跟踪了目标1。确定并比较打算怀孕的艾滋病毒不一致夫妇的艾滋病毒发病率， 与那些不打算怀孕的人相比，每6个月进行一次快速艾滋病毒检测，持续2年。 目标2.描述和比较性行为、避孕、避孕套的使用、夫妻行为和 因素和社会文化规范，使用快速尿妊娠试验和音频计算机辅助 每6个月进行一次二分体中每个成员的自我访谈，持续2年。目标3。开发了一个理论 社会行为模式的生殖决策过程如何影响艾滋病毒传播的风险。 该模型将使用目标1和目标2的数据以及通过二元访谈收集的定性数据来开发 （n=30）和12个焦点小组讨论（艾滋病毒阴性男性、艾滋病毒阴性女性、艾滋病毒阳性男性， HIV阳性女性），在基线和第18个月进行。我们将把理论模型元素应用于 队列数据使用结构方程模型来评估其在预测HIV事件和妊娠方面的价值。 将在肯尼亚举行一次政策会议，讨论研究结果。这项研究将大大有助于 设计干预措施，减少资源有限环境中艾滋病毒的横向和纵向传播。项目叙述 这项研究解决了一个研究不足和紧迫的全球公共卫生问题： 艾滋病与生殖健康行为，以减少艾滋病传播。该研究在方法上 创新，因为它将社会行为和流行病学数据纳入一个前瞻性的、以社区为基础的 设计调查结果有可能为改进艾滋病毒和生殖服务的综合提供提供信息， 在艾滋病毒高负担和普遍流行的资源有限的环境中，

ABSTRACT Mature HIV epidemics in high prevalence regions are characterized by significant HIV discordance rates in stable relationships, representing considerable HIV transmission risk. The pandemic primarily affects those in peak years of childbearing, who may not be aware of their HIV status or use condoms. Intentional childbearing may place heterosexual couples at risk of HIV infection in resource-limited settings with high HIV prevalence areas where society places great value on having children. We propose a community-based prospective cohort study that will offer home-based HIV counseling and testing to heterosexually active couples and obtain reproductive and sexual health data, and pregnancy and HIV incidence from men and women in Nyando district, western Kenya. A randomly-selected cohort of HIV discordant (n?960), concordant-negative (subset of n?960) and concordant-positive (n?480) couples will be followed. Aim 1. Determine and compare HIV incidence among HIV-discordant couples who intend pregnancy, versus those who do not intend to become pregnant, using rapid HIV assays every 6 months for 2 years. Aim 2. Describe and compare sexual behaviors, contraception, condom use, couple-level behaviors and factors, and sociocultural norms in the cohort, using rapid urine pregnancy tests, and audio computer-assisted self interviews from each member of the dyad, every 6 months for 2 years. Aim 3. Develop a theoretical sociobehavioral model of how reproductive decision-making processes influence the risk of HIV transmission. This model will be developed using Aims 1 and 2 data as well as qualitative data collected via dyad interviews (n=30) and 12 focus group discussions (among HIV-negative males, HIV-negative females, HIV-positive males, HIV-positive females), conducted at baseline and at month 18. We will apply the theoretical model elements to the cohort data using structural equation modeling to assess its value in predicting incident HIV and pregnancy. A policy meeting will be held in Kenya to discuss study findings. This study will contribute significantly to design of interventions to reduce horizontal and vertical HIV transmission in resource-limited settings. Project Narrative This research addresses an under-studied and urgent global public health issue: improved understanding of HIV and reproductive health behaviors in order to reduce HIV transmission. The study is methodologically innovative as it integrates sociobehavioural and epidemiological data in a prospective, community-based design. Findings have the potential to inform improved, integrated delivery of HIV and reproductive services to heterosexual couples in resource-limited settings with high HIV burden and generalized epidemics.