Sexual and reproductive health for people living with HIV/AIDS
The Discordant Couples Project: Understanding the family planning needs of HIV - discordant couples in urban Kenya
Investigators will explore the family planning needs of HIV-discordant couples – where only one of the partners is infected with HIB – in Kenya and to generate empirical data that will help inform the development of family planning programmes that are sensitive to their unique needs; programmes that move beyond the conventional models as well as the constraints imposed by the conceptualization of family planning interventions in terms of spatial or temporal distance from the point of disease transmission. In doing this, investigators will work with concepts that have been linked to the risk for sero-conversion including inconsistent use of condoms, non-use of voluntary counselling and testing services, and non-disclosure of HIV status.
In-depth interviews will be conducted with 30 - 33 sero-discordant couples who are members of a local NGO, Discordant Couples of Kenya (DISCOK), which provides support to discordant couples in Nairobi. The aim of the research will be to conduct an initial individual interview with each participant, followed up with one joint-couple interview, and a final individual interview. There will also be individual interviews with 15-20 key informants affiliated with sexual and reproductive health provision, advocacy, and policy development.
The research aims:
- to develop a deeper, ethnographic understanding of the family planning needs of HIV discordant couples;
- to "problematize" concepts that are central to the prevention of HIV from public health perspectives (e.g. contraception ‘adherence’ and ‘compliance’), and to show how the use (or non-use) of family planning functions in the unique world of these couples;
- to use the ethnographic data as a basis for thinking critically and creatively about the forms that programmatic action to address the family planning needs of HIV-discordant couples might take.
Reproductive health needs of people living with HIV-1 infection in rural Kilimanjaro, Tanzania: magnitude and determinants
The main aim of the study is to investigate the prevalence and determinants of reproductive health needs (fertility desires and intentions, family planning choices and use) among people living with HIV in rural Tanzania. Additionally, this study aims to explore demographic, medical and sociocultural factors affecting reproductive needs of people living with HIV (PLHIV). Specifically, the study aims to explore the following:
- assess the prevalence and determinants of fertility desires and intention among HIV positive individuals;
- investigate the prevalence of various family planning (FP) methods used by PLHIV;
- explore how HIV/AIDS diagnosis and use of ART shape use and choice of FP methods;
- determine the level of disclosure of FP use and level of partner involvement in the choice of FP methods;
- assess individual, societal and cultural factors affecting the reproductive needs of people living with HIV infection.
The investigators will recruit HIV positive individuals from the HIV counselling centre, KIWAKUKKI located in Oria village that serves 11 villages of Kahe wards in rural Kilimanjaro, Tanzania. Inclusion criteria are defined as: 1) having a definitive HIV positive test; (2) resident of Kahe ward; and (3) being within the age group 14-49 years. In addition, two homogeneous focus group discussions are planned, one for men and one for women. Discussions will inform development and refinement of the survey instrument.
The study will involve one round of data collection to assess the magnitude and associated factors for family planning and fertility desires and intentions among PLHIV in Kahe ward. This project was recently approved by the WHO Ethics Review Committee.