title: Periconception HIV Risk Behavior Among Men and Women Reporting HIV-Serodiscordant Partners in KwaZulu-Natal, South Africa.
abstract: HIV-infected men and women who choose to conceive risk infecting their partners. To inform safer conception programs we surveyed HIV risk behavior prior to recent pregnancy amongst South African, HIV-infected women (N = 209) and men (N = 82) recruited from antenatal and antiretroviral clinics, respectively, and reporting an uninfected or unknown-HIV-serostatus pregnancy partner. All participants knew their HIV-positive serostatus prior to the referent pregnancy. Only 11 % of women and 5 % of men had planned the pregnancy; 40 % of women and 27 % of men reported serostatus disclosure to their partner before conception. Knowledge of safer conception strategies was low. Around two-thirds reported consistent condom use, 41 % of women and 88 % of men reported antiretroviral therapy, and a third of women reported male partner circumcision prior to the referent pregnancy. Seven women (3 %) and two men (2 %) reported limiting sex without condoms to peak fertility. None reported sperm washing or manual insemination. Safer conception behaviors including HIV-serostatus disclosure, condom use, and ART at the time of conception were not associated with desired pregnancy. In light of low pregnancy planning and HIV-serostatus disclosure, interventions to improve understandings of serodiscordance and motivate mutual HIV-serostatus disclosure and pregnancy planning are necessary first steps before couples or individuals can implement specific safer conception strategies.
authors.affiliation: Division of Infectious Disease and Center for Global Health, Massachusetts General Hospital, 100 Cambridge Street, 15th Floor, Boston, MA, 02114, USA. ltmatthews@partners.org.
authors.forename: L T
authors.initials: LT
authors.lastname: Matthews
authors.affiliation: MatCH Research [Maternal, Adolescent and Child Health Research], Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.|School of Pharmacy and Pharmacology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: J A
authors.initials: JA
authors.lastname: Smit
authors.affiliation: MatCH Research [Maternal, Adolescent and Child Health Research], Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
authors.forename: L
authors.initials: L
authors.lastname: Moore
authors.affiliation: MatCH Research [Maternal, Adolescent and Child Health Research], Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
authors.forename: C
authors.initials: C
authors.lastname: Milford
authors.affiliation: MatCH Research [Maternal, Adolescent and Child Health Research], Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Greener
authors.affiliation: MatCH Research [Maternal, Adolescent and Child Health Research], Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
authors.forename: F N
authors.initials: FN
authors.lastname: Mosery
authors.affiliation: Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA, USA.
authors.forename: H
authors.initials: H
authors.lastname: Ribaudo
authors.affiliation: Bennett Statistical Consulting, Inc., Ballston Lake, NY, USA.
authors.forename: K
authors.initials: K
authors.lastname: Bennett
authors.affiliation: Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.
authors.forename: T L
authors.initials: TL
authors.lastname: Crankshaw
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Kaida
authors.affiliation: Behavioral Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Psaros
authors.affiliation: Behavioral Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Safren
authors.affiliation: Division of Infectious Disease and Center for Global Health, Massachusetts General Hospital, 100 Cambridge Street, 15th Floor, Boston, MA, 02114, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Bangsberg
mesh_terms: D000328:Adult; D017280:Condoms; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission*; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D011247:Pregnancy; D012309:Risk-Taking; D021841:Safe Sex; D012725:Sexual Behavior; D012747:Sexual Partners; D013019:South Africa; D055815:Young Adult
keywords: PMTCT; Safer conception; Serodiscordant couples; South Africa