Reproductive health decisions and HIV infection risk

描述（由申请人提供）：在高流行率地区，成熟的艾滋病毒流行的特点是稳定关系中的艾滋病毒不一致率很高，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处于生育高峰年的人，他们可能不知道自己的艾滋病毒状况或使用避孕套。在资源有限、艾滋病毒流行率高的地区，社会非常重视生育子女，在这些地区，有意生育可能会使异性夫妇面临感染艾滋病毒的风险。我们提出了一个以社区为基础的前瞻性队列研究，将提供以家庭为基础的艾滋病毒咨询和检测异性恋活跃的夫妇，并获得生殖和性健康数据和怀孕和艾滋病毒的发病率从男性和女性在Nyando区，肯尼亚西部。随机选择的HIV不一致队列（n？960），一致阴性（子集的n？960)一致性阳性（n？480)情侣们将被跟踪。目标1。确定和比较艾滋病毒感染不一致的夫妇谁打算怀孕，与那些谁不打算怀孕，使用快速艾滋病毒检测，每6个月为2年。目标2.描述和比较队列中的性行为，避孕，避孕套的使用，夫妇水平的行为和因素，以及社会文化规范，使用快速尿妊娠试验和音频计算机辅助自我访谈，每6个月一次，持续2年。目标3。建立一个关于生育决策过程如何影响艾滋病毒传播风险的理论社会行为模型。该模型将使用目标1和2数据以及通过在基线和第18个月进行的二元访谈（n=30）和12次焦点小组讨论（HIV阴性男性、HIV阴性女性、HIV阳性男性、HIV阳性女性）收集的定性数据开发。我们将使用结构方程模型将理论模型元素应用于队列数据，以评估其在预测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，以减少在资源有限的情况下艾滋病毒的横向和纵向传播。

DESCRIPTION (provided by applicant): 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.