Pilot Award

In sub-Saharan Africa, HIV is predominantly transmitted via discordant sexual relationships. With the availability of antiretroviral (ARV) medications, individuals infected with HIV can live relatively normal productive lives. Societal and cultural expectations as well as personal reproductive intentions drive HIV positive women in discordant relationships to conceive. Approximately 50% of HIV infected couples desire children. However, a safe and effective method of conception that minimizes the risk of sexual HIV transmission in HIV discordant couples with a positive woman and negative man (female+/male-) has yet to be examined. To date, published studies have evaluated assisted reproductive methods in HIV discordant couples with a positive man to decrease the risk of HIV transmission. We intend to evaluate the acceptability, feasibility and efficacy of vaginal insemination with semen for conception in (female+/male-) HIV discordant relationships in Kenya. In this pilot study, (female+/male-) HIV discordant couples desiring pregnancy will receive targeted reproductive counseling through the Safer and Healthy Conception Program (SHCP) for 6 months. This program will emphasize the consistent use of condoms and teach couples assisted vaginal insemination for conception to minimize the risk of sexual HIV transmission. We will compare the frequency of condom use before and after the intervention with an audio computer-assisted self-interview (ACASI) validated by random measurement of prostate specific antigen (PSA) of vaginal secretions. The incidence of pregnancy following vaginal insemination will also be measured. We hypothesize that our findings will provide evidence to support the routine use of vaginal insemination as a safe method of conception in (female+/male-) HIV discordant couples. This study is of significant public health importance because the use of vaginal insemination for conception in (female+/male-) HIV discordant couples is expected to reduce the likelihood of riskier sexual practices for childbearing and decrease the incidence of HIV in sub-Saharan Africa.