title: Community perceptions of childbearing and use of safer conception strategies among HIV-discordant couples in Kisumu, Kenya.
abstract: BACKGROUND
  Safer conception strategies (SCS) have the potential to decrease HIV transmission among HIV-discordant couples who desire children. Community perceptions of SCS may influence the scale-up and uptake of these services, but little is known about how communities will react to these strategies. Without community support for SCS, their success as an HIV prevention tool may be limited. The objective of this study is to characterize community perceptions of SCS for HIV-discordant couples in Kisumu, Kenya, to inform ongoing and future safer conception intervention studies in low-resource settings.
  
  
  METHODS
  We conducted six focus group discussions and 11 in-depth-interviews in Kisumu, Kenya, among a diverse group (N=59) of community members, including men, women, youth (age 19-25), community health workers and local leaders. An iterative qualitative analysis using a grounded theory approach was employed.
  
  
  CONCLUSIONS
  All participants emphasized the importance of childbearing in their society and the right to have children, regardless of an individual's HIV status. While most participants believed that HIV-discordant couples should be allowed to have children, they discussed several barriers to the uptake of SCS such as HIV-related stigma, fear of HIV transmission to the uninfected partner and child, fear of unfamiliar medical procedures and lack of information among community members and health care providers about HIV prevention interventions that allow safer conception. Access to information, community experiences with successful safer conception interventions, healthcare provider training, male engagement and community mobilization may help overcome these barriers. Though assisted reproduction strategies generated the most negative reactions from participants, our results suggest that with education and explanation of these services, participants express interest in these strategies and want them to be offered in their community.
  
  
  CONCLUSIONS
  Many community members noted a need and desire for safer conception education and services in Kisumu. However, community barriers such as fear, stigma and lack of information should be addressed before safer conception interventions can be successfully implemented and delivered. Further research focused on community education, male engagement and healthcare provider training is a crucial next step in delivering safer conception in this region.
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA; brooke.breitnauer@ucdenver.edu.
authors.forename: Brooke T
authors.initials: BT
authors.lastname: Breitnauer
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan Medical School and Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.
authors.forename: Okeoma
authors.initials: O
authors.lastname: Mmeje
authors.affiliation: Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Betty
authors.initials: B
authors.lastname: Njoroge
authors.affiliation: Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA.
authors.forename: Lynae A
authors.initials: LA
authors.lastname: Darbes
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Leddy
authors.affiliation: Department of Epidemiology and Biostatistics, and Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
authors.forename: Joelle
authors.initials: J
authors.lastname: Brown
mesh_terms: D000328:Adult; D001290:Attitude; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception
keywords: HIV prevention; HIV transmission; HIV-discordant couples; childbearing; community perceptions; pregnancy; safer conception