Desire for Pregnancy, Contraception, and HIV Risk among Serodiscordant Couples.

DESCRIPTION (provided by applicant): Most HIV-infected individuals are in their reproductive years. In light of treatment advances that have significantly prolonged survival, improved perinatal prophylaxis, as well as increased access to assisted reproductive techniques [ART] that can reduce the risks of horizontal transmission, many of these individuals desire to have a child. Nevertheless, to date there is still a paucity of research on HIV-infected men's fertility- related desires and behavior, especially in the US. Individuals in a serodiscordant relationship who attempt natural conception confront the risks of both horizontal and vertical transmission. Available data on heterosexual serodiscordant couples suggest that a substantial proportion of them engage in unprotected sex in their usual sexual behavior. Further, the availability of more effective treatments for HIV disease may have led to a greater willingness among these couples to assume the risks of unprotected sex. Although reproductive dilemmas are a key emotional issue facing serodiscordant couples, very little is known about how these couples think, negotiate and communicate about their desires for having or not a child, using or not contraception, and how their sexual behavior may differ in the context of contemplating pregnancy or attempting conception or desiring to avoid conception. To investigate these issues, we propose a qualitative study of 100 serodiscordant heterosexual couples (50 with a HIV+ male partner and 50 with an HIV+ female). The specific aims are: 1. To investigate each partner's desire, motives, and deterrents for having a child within a serodiscordant couple. 2. To investigate each partner's perceptions of the risks of horizontal and vertical transmission in the context of conception and their knowledge and beliefs regarding opportunities for managing these transmission risks. 3. To investigate each partner's willingness to engage in unprotected sex and tolerate the risks of transmission and pregnancy, and also the strategies used to manage these risks and the reasons for using them. 4. To investigate how partners in serodiscordant relationships negotiate and communicate about pregnancy, contraception, and HIV risk. 5. To investigate each partner's perceptions and experiences of support or discouragement of their reproductive goals from health care providers and family.