Enhanced HIV Prevention in Couples: Feasibility Study #1

Studies to date indicate that HIV negative partners within HIV-discordant couples (where one partner is HIV+ and the other is HIV-) are at substantial risk of acquiring HIV infection and that such transmission may play animportant role in heterosexual transmission of HIV in countries with high seroprevalence in sub-Saharan Africa. The purpose of this study is to conduct preparatory research needed to design and implement an HIV-prevention intervention trial aimed at decreasing the risk for HIV infection among HIV-discordant couples in Lesotho.

Using both quantitative and qualitative research methods, the study aims to:

• Establish baseline characteristics of the proposed study population, specifically pregnant and recently postpartum women and of men in Lesotho
• Explore the types of sexual and social relationships that exist between men and women in Lesotho
• Assess individual knowledge, understanding and perceptions around different HIV prevention strategies, including HIV testing and treatment, couples counseling and male circumcision
• Identify interpersonal and individual-level barriers to accessing these types of HIV prevention interventions.

There will be three study components including 1) quantitative survey 2) focus group discussions; and 3) in-depth individual interviews. A quantitative cross-sectional survey will be administered to 200 pregnant and recently postpartum women. Qualitative components will be based on open-ended iterative inquiry via focus group discussions and in-depth interviews with two groups: (1) pregnant and recently postpartum women; and (2) men. Data gathered during this study will inform the study design and intervention components of the proposed prevention intervention study.

Inclusion criteria

Women's Quantitative Survey

• Women at least 18 years of age
• Pregnant or within 6 months postpartum
• Receiving antenatal care at target clinic
• Ability to speak English or Sesotho

Women's Focus Group Discussion

• All inclusion criteria listed in Women's Quantitative Survey AND
• Ability to speak Sesotho, specifically
• Willingness to disclose HIV status within FGD
• Willingness to allow audio- recording of FGD

Male Individual Interviews

• Men between 18 and 50 years of age
• Living or working in one of the two targeted districts
• Ability to speak Sesotho
• Willingness to allow audio- recording of interview

Exclusion criteria

• Individuals meeting any of the exclusion criteria will be excluded from study participation.

For all quantitative and qualitative components

• Individuals who do not meet the inclusion criteria outlined above
• Any condition which in the opinion of the investigators would interfere with adherence to study requirements