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This project has two primary aims: 1. Identify barriers and facilitators for heterosexual couples pertaining to utilizing couples-based voluntary counseling and testing (CBVCT) in Soweto, South Africa 2. Identify relationship-based predictors of HIV risk behavior in couples (e.g., communication, intimacy, commitment, etc.). The study is comprised of two phases. The first phase was qualitative in nature, and focused on obtaining information from men and women regarding their relationships and their perceptions and attitudes about couples-based testing for HIV. Both individual interviews and focus groups were conducted (N=48, 16 couples in individual interviews and eight couples in focus groups). Data collection was completed for this phase in February of 2006. The second phase was a cross-sectional quantitative study of predictors of HIV risk behavior and of utilizing couples-based testing among a sample of 220 couples. The survey included questions about relationship dynamics, such as trust and communication, as well as social norms regarding HIV testing. This project finished data collection in December of 2008. The research is based at the Chris Hani Baragwanath Hospital and the Perinatal HIV Research Unit at the University of the Witwatersrand in Johannesburg, South Africa.

This project conducted in-depth qualitative interviews with couples (n=20) key informants (n=12), and focus groups (n=4) regarding the feasibility and acceptability of a comprehensive couples-based intervention. Key issues were explored to determine potential interest for intervention content. The research is based at the Chris Hani Baragwanath Hospital and the Perinatal HIV Research Unit at the University of the Witwatersrand in Johannesburg, South Africa. The primary aims of the project were to:

• Determine the ideal components of an integrated package delivering comprehensive HIV and reproductive health services to heterosexual couples in Soweto, South Africa.
• Explore the feasibility and acceptability of such a program via in-depth interviews with potential target audience members and key informants.

This study tests the efficacy of an intervention utilizing HIV rapid testing and integration of HIV Voluntary Counseling and Testing (VCT) into Tuberculosis (TB) evaluation and home-based VCT for family members, to overcome identified logistical and psychological barriers to HIV VCT among new TB patients and their family members. The specific aims of the study are:

1. To determine the uptake of and barriers to HIV VCT among a cross-sectional sample of 2,000 TB evaluation patients offered same-day results HIV counseling and testing at the Uganda National TB and Leprosy Programme outpatient TB clinic at Old Mulago Hospital in Kampala, Uganda
2. To conduct a randomized trial of HIV VCT among 600 households comparing VCT uptake between home-based VCT and TB clinic-based VCT for family and household members of TB evaluation patients
3. To investigate the effectiveness of home-based and TB clinic-based VCT in linking HIV+ persons to HIV medical care and social support

Through this study’s dissemination plan and the proposed policy and community forums, information on a successful model could be made rapidly available to key stakeholders responsible for setting national policy and local HIV/AIDS control programs.

This 5-year research program addresses a neglected topic of HIV prevention research: HIV risks to female migrants in sub-Saharan Africa. The research uses mixed quantitative and ethnographic methods to investigate how migration and mobility facilitate women’s risks of acquiring and transmitting HIV infection. The first phase of the research in Kisumu, Kenya aims to

• Describe women’s patterns of migration and mobility, and the spatial and social features of the common destinations of female migrants
• Identify the social, environmental and structural aspects of women’s migration which render it particularly hazardous vis-à-vis HIV risks
• Describe HIV-related beliefs, attitudes and sexual risk behaviors among female migrants The ultimate aim of this research is to develop and test a multi-level HIV prevention intervention with female migrants in western Kenya.

The Maternity in Migori and AIDS Stigma Study (MAMAS Study) aims to understand the effects of HIV/AIDS stigma on service use by pregnant women in rural Kenya, and to use the knowledge gained to develop stigma reduction interventions for this vulnerable group. The research plan includes a prospective study of women who use antenatal care (ANC) services at clinics in Migori and Rongo Districts in Nyanza Province, Kenya, as well as qualitative research to elucidate the potential role of HIV/AIDS stigma as a barrier to health service use among women in the community who do not use ANC services. The MAMAS prospective study includes interviews with childbearing women at their first ANC visit, during late pregnancy, and after the birth. Around 1800 pregnant women who come to ten clinics for their first ANC visit and do not yet know their HIV status are being interviewed before their first visit to assess their perceptions of HIV/AIDS stigma, uptake of HIV testing, and other variables. A subsample of these women (n=900) are re-interviewed during their last month of pregnancy and then again at six weeks postpartum to assess changes in perceptions and experiences of stigma, number of ANC visits completed, place of delivery, postpartum checkups, and enrollment in HIV care and treatment. The qualitative research component will consist of in-depth interviews with:

• Women who did not use maternity services for a recent pregnancy
• Traditional birth attendants
• Community health workers
• Male partners of women who did not use maternity services

The final step will be to integrate the findings from the quantitative and qualitative data and use them to guide the development of an intervention to reduce HIV/AIDS stigma that adversely affects pregnant women in Kenya.