Contraception, fertility planning and HIV-1 risk among African HIV-1 serodiscordant couples

Abstract

Abstract <bold>Contraception, fertility planning and HIV-1 risk among African HIV-1 serodiscordant couples</bold> Renee Heffron Chair of the Supervisory Committee: Jared M. Baeten, Associate Professor Departments of Global Health, Medicine and Epidemiology The studies within this dissertation describe contraception and fertility planning and their relationship to HIV-1 risk among African HIV-1 serodiscordant couples. Specifically, this work 1) describes correlates of contraceptive use, 2) assesses the relationship between contraceptive use and HIV-1 transmission risk, and 3) explores whether new prevention strategies would be a welcomed option. Hormonal contraception lies at the interface of reproductive health and HIV-1 prevention programs. Safe and effective contraception can reduce maternal mortality and improve infant and maternal health through birth spacing. With these benefits, however, hormonal contraceptive use among women with and at-risk for HIV-1 is low and is correlated with less frequent condom use. Some epidemiological studies-including ours-have demonstrated an increased HIV-1 acquisition risk among women using hormonal contraception, further linking the family planning and HIV-1 prevention communities. At this time, the evidence is inconclusive and recommendations to modify family planning guidelines for women at high HIV-1 risk are not warranted but this question remains of great public health importance. Low rates of contraceptive use may be indicative of high fertility desires and antiretrovirals may offer HIV-1 serodiscordant couples strategies to reduce their HIV-1 transmission risk when they desire children. Not all HIV-1 infected participants in our study indicated willingness to initiate antiretrovirals for HIV-1 prevention purposes, however, and incorporating individual preferences into HIV-1 prevention counseling will remain imperative. The work detailed in this dissertation will be potentially used to guide HIV-1 prevention and family planning programs for African HIV-1 serodiscordant couples and the results have already contributed landmark findings to these fields. Much work remains to control the African HIV-1 epidemic but the promise of HIV-1 prevention programs that incorporate antiretrovirals and are integrated with reproductive health services are fueling policy makers, researchers and providers to ensure these programs are successfully implemented to achieve great impact.