Prevention and Planning Linkages

描述（由申请人提供）：撒哈拉以南非洲的男性和女性开始他们的生殖生活，面临着艾滋病毒感染和怀孕计划的双重挑战。乌干达的Rakai区是过去二十年来普遍存在艾滋病毒流行病的地区，艾滋病毒流行率为11%，目前未满足的计划生育需求为52%。相对稳定的艾滋病毒发病率加上治疗选择意味着今天许多育龄人口将与艾滋病毒一起生活多年。然而，迄今为止，我们对艾滋病毒治疗和预防如何塑造男性、女性和夫妇的生育愿望、行为和结果以及生育如何影响艾滋病毒预防知之甚少。 为了弥补这一差距，拟议的预防和规划联系（联系）项目的第一个目标是在区域社区服务中心内比较来自四个艾滋病毒一致群体（双方都是艾滋病毒阳性或阴性）和不一致群体（任何一方的性伴侣都是艾滋病毒阳性）的夫妇，检查男子和妇女的生育愿望、行为和结果;夫妇之间的协议;未满足的避孕需求;以及获得/利用艾滋病毒和生殖健康服务。考虑到男性和女性在生育决策中的重要性，我们的调查将侧重于夫妇双方在此类决策中的作用。使用混合方法-使用纵向队列数据和对夫妇的深入访谈-我们的目标是提供一个全面的观点，对生育的愿望，艾滋病毒和谐和不和谐的夫妇的看法和行为。第二，联系项目将探讨艾滋病毒阳性和艾滋病毒阴性妇女的生育愿望、行为和结果的趋势，这些趋势与拉卡伊艾滋病毒预防和治疗计划的两个阶段有关：1-预防母婴传播的可获得性，2-抗逆转录病毒疗法的可获得性。水平的队列，以及这些愿望如何受到艾滋病毒流行和治疗方案不断变化的动态的影响。我们将使用来自RCCS的性活跃妇女的历史数据，研究乌干达农村艾滋病毒治疗和预防计划两个阶段中艾滋病毒阳性和艾滋病毒阴性妇女的生育愿望，行为和结果的趋势。最后，“联系”项目将确定在感染血清转化前后、血清转化后和了解个人或伴侣感染后，区域社区卫生服务中心妇女和男子的生育意愿和行为轨迹。重要的是要检查生育意愿的个体水平差异， 艾滋病毒血清转换前后的行为，因为这样的前瞻性分析使我们能够更好地了解艾滋病毒检测，艾滋病毒咨询和治疗对生育相关的愿望和行为的影响，同时对个人的人口统计学和社会特征进行调节。为此，我们将再次使用混合方法设计-使用纵向队列数据和匹配的“病例-对照”定性访谈-检查女性和男性之间的受试者内变化。

DESCRIPTION (provided by applicant): Men and women in Sub Saharan Africa begin their reproductive lives facing the dual challenge of HIV infection and pregnancy planning. The Rakai district of Uganda represents a region where a generalized HIV epidemic has existed for the last two decades, where HIV prevalence is 11% and where the current unmet need for family planning is at 52%. Relatively stable HIV incidence coupled with treatment options means that today many people of reproductive age will live with HIV for many years. To date however, we know little about how HIV treatment and prevention shapes the fertility desires, behaviors, and outcomes of men, women, and couples - and how fertility influences HIV prevention. To address this gap, the proposed Prevention and Planning Linkages (Linkages) project first aims compare couples from four HIV concordant (both partners HIV+ or HIV-) and discordant groups (either sexual partner is HIV+) within the RCCS, examining men's and women's fertility desires, behaviors, and outcomes; agreement within couples; unmet need for contraception; and access to/utilization of HIV and RH services. Given the importance of both men and women in fertility decision-making, our investigations will focus on the role of both members of a couple in such decision-making. Using a mixed- method approach - used longitudinal cohort data and in-depth interviews with couples - we aim to provide a comprehensive perspective on the fertility desires, perceptions and behaviors of HIV concordant and discordant couples. Second, the Linkages project will explore trends in fertility desires, behaviors, and outcomes among HIV+ and HIV- women in relation to two phases of HIV prevention and treatment programs in Rakai: 1- post-availability of PMTCT and 2- post availability of ART. There is a dearth of research on fertility desires among a population-level cohort and how these desires have been affected by the changing dynamic of the HIV epidemic and treatment options. We will use historical data from sexually active women from the RCCS, to examine the trends in the fertility desires, behaviors and outcomes among HIV positive and HIV negative women over two phases of HIV treatment and prevention programs in rural Uganda. Finally, the Linkages project will identify trajectories i fertility desires and behaviors among women and men in the RCCS prior to and after seroconversion to infection, after seroconversion, and after gaining knowledge of personal or partner's infection. It is important to examine individual level variation in fertility desires and behaviors before and after HIV sero-conversion, as such a prospective analysis allows us to better understand the influence of HIV testing, HIV counseling and treatment on fertility related aspirations and behaviors, while conditioning on individual demographic and social characteristics. For this aim we will again use a mixed-method design - using longitudinal cohort data and matched 'case-control' qualitative interviews - to examine within-subject change among women and among men.