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Three recent independent national datasets suggest that the rate of new HIV infections in Botswana appears to be declining, as evidenced by decreased prevalence among pregnant women aged 15-49. However, it is still uncertain why these declines have been observed and the extent to which behavioral changes (e.g., monogamy, condom use) have been causally associated with the decline. The goal of this study is to use qualitative research methods to lend additional depth to existing surveillance data that suggest that HIV prevalence among young people in Botswana is declining. Focus group discussions and individual in-depth interviews are conducted with

• Local youth service providers
• Youth between the ages of 18-24
• Adult key informants in three districts selected for regional diversity and variation of trends in HIV prevalence

By gathering information from young people and key informants who provide health-related services to young Batswana, we will gain valuable insight into the behavioral and contextual factors that may assist in explaining the observed decreases in HIV prevalence. Qualitative methods will allow us to explore the meanings and variations of the sexual experiences of young Batswana. This work may also lead to the development of innovative behavior change strategies to help support the decreased spread of HIV in Botswana.

South Africa is the country most impacted by HIV in the world—of 49 million people, 5.6 million are infected with HIV. In 2011 the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and Centers for Disease Control and Prevention (CDC) responded to the epidemic crisis by stepping up prevention partnerships across South Africa through support for comprehensive HIV/TB prevention programs. The International Training and Education Center for Health in South Africa (I-TECH) was awarded funds to partner with the North West Province Department of Health (NWDOH), Empowerment Concepts, the University of California San Francisco’s Center for AIDS Prevention Studies, LifeLine and Soul City to develop, implement, and evaluate a comprehensive HIV prevention program in the province. Comprehensive prevention packages incorporate biomedical, behavioral and structural interventions, recognizing there is no silver bullet to prevent HIV but “that the optimal set of interventions implemented with quality and to scale can significantly reduce HIV incidence.” UCSF has supported this work by conducting a situational analysis, to tailor the programming to the local context; providing technical assistance in programming components; creating an infrastructure for community engagement through community working groups; supporting quality assurance, monitoring and evaluation; and leading an impact assessment of the project.

The goal of this study is to develop a preliminary understanding of the social and cultural context in which HIV serodiscordant couples in Kenya are making the decision to become pregnant. The specific aims of this study are:

• To explore the motivations for conception, understanding the risk of HIV transmission, and the decisionmaking process of serodiscordant couples desiring pregnancy.
• To assess the acceptability of:
• Limiting unprotected intercourse to the fertile window in a woman’s cycle to reduce the number of episodes of unprotected sex per month.
• Providing the HIV- partner with antiretroviral medication to take prior to unprotected intercourse to reduce the risk of HIV transmission.
• Starting antiretroviral medication in the HIV+ partner, regardless of immune status and clinical staging to reduce genital tract viral shedding and possibly HIV transmission.
• Sperm washing to isolate spermatozoa from semen of HIV+ men, followed by intrauterine insemination using the prepared sperm in order to achieve pregnancy while preventing HIV transmission.

The study tool will consist of a structured questionnaire, followed by an in-depth interview. Fifteen discordant couples of reproductive age who express a general desire to have children in the future will be recruited from an existing AIDS care program in Kisumu, Kenya. Findings from this study will be used to design an investigation to determine the uptake and acceptability of these potential HIV prevention strategies.

To continue UCSF’s commitment in helping the CDC’s Global AIDS Program (GAP) achieve its goals in GAP countries and regions, this project will strengthen local capacity, as well as collect vital data on the HIV epidemic among Sex Workers (SW) in South Africa. To this end this project has 4 objectives:

1. To estimate the prevalence of HIV and syphilis, and associated risk behaviors among female sex workers in Johannesburg, Cape Town, and Durban, South Africa.
2. To estimate the population size and distribution of SW’s at these three locations.
3. To identify and assess determinants of access and utilization of health and social welfare programs in South Africa among sex workers.
4. To enhance the national capacity to conduct Integrated Bio-Behavioral Surveillance (IBBS) for key populations in South Africa as a key component of a strengthened second generation national HIV surveillance system.

This study is the first of its kind in South Africa and will be conducted in Johannesburg, Durban, and Cape Town. We will use key informant interviews, focus group discussions, and mapping as an initial Formative Assessment to guide the implementation of a more in-depth IBBS.

This project is designed to assess logistical and sociocultural challenges involved in promoting male circumcision (MC) as a method of HIV prevention. The project took place in two sites: Mutoko, a rural district in the Mashonaland East Province of Zimbabwe and Vulindlela, a rural district in the province of KwaZulu-Natal, in South Africa. These communities are high HIV prevalence, resource-limited environments where MC is not traditionally practiced. The goal of this study is to better understand how to incorporate the concept of MC into broader HIV prevention planning for sub-Saharan Africa. Sixteen in-depth interviews were conducted with eight traditional, political, and religious leaders and health care providers key informants at each site. Eight focus group discussions (four focus groups per site) were conducted with community members separated by age and gender: younger men, younger women (ages 18-24 years); older men, older women (25 years and older).