The massive rollout of antiretroviral therapy (ART) and of Prevention of Mother-to-Child Transmission (PMTCT) programs in many sub-Saharan countries is rapidly and radically changing the epidemiological and social meanings and implications of HIV/AIDS. The proposed study will focus on the intersections of childbearing with the scaling-up of HIV Voluntary Counseling and Testing (VCT) and treatment and resulting changes in individuals'knowledge and views about HIV infection and its consequences. It will combine different types of data collection and analysis to build upon the research team's previous work (R21HD048257, Agadjanian PI) in four contiguous rural districts of southern Mozambique, an area of precipitous erosion of traditional agrarian livelihoods, massive labor mobility, profound changes in marriage and family systems, high and growing HIV prevalence, and a vigorous expansion of VCT/ART/PMTCT. The scientific aims of the study are to examine in this changing context: how rural women's knowledge and perceptions of own HIV status affect their reproductive intentions, contraceptive choices, and fertility outcomes;how the characteristics of rural women's social environments influence the above relationships;how institutional characteristics and mechanisms of the Maternal and Child Health (MCH) clinics affect the ability of HIV+ and HIV- rural women to implement their reproductive intentions and contraceptive preferences. A separate aim of the project is to develop and disseminate practical recommendations on the basis of the analyses. To achieve these aims, the five-year project will use a longitudinal design that will involve two waves of population-based survey and of qualitative data collection. The two waves of survey will re-interview a representative sample of c. 1680 married rural women residing in 54 villages who were first interviewed for an earlier study in 2006. In parallel to the individual survey, in each village, a community survey will be carried out. In addition to the surveys, 72 of the survey respondents from eight of the sampled villages (nine per village), with whom semi-structured in-depth interviews were conducted in 2006, will participate in two waves of in- depth interviews. To complement the individual/household and community perspectives with an institutional one, in every year of the project, statistical data on MCH/VCT/PMTCT service provision and utilization will be collected from the districts'MCH clinics and in-depth interviews focusing on challenges and barriers involved will be carried out with the clinics'nurses. The results of the project will contribute to a better understanding of changes effected by the evolving HIV/AIDS landscape in reproductive intentions and behaviors and to the optimization of the integration of MTC with VCT/PMTCT services and improvement of rural women's access to these services. Project Narrative The project will examine how rural women's knowledge or perceptions of their HIV status affect their reproductive and contraceptive preferences, choices and outcomes in the context of rapidly increasing availability of HIV testing and treatment in Mozambique. It will build upon the research team's previous work in that country and will involve collection and analyses of longitudinal population survey, qualitative, and institutional data. The results of the project will advance the understanding of the relationships between HIV/AIDS and childbearing and will contribute to the optimization of rural maternal and child health and prevention of mother-to-child HIV transmission services.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Study Section
Special Emphasis Panel (ZHD1-DSR-W (20))
Program Officer
Newcomer, Susan
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Arizona State University-Tempe Campus
Social Sciences
Schools of Arts and Sciences
United States
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Yabiku, Scott T; Agadjanian, Victor (2017) Father's Labour Migration and Children's School Discontinuation in Rural Mozambique. Int Migr 55:188-202
Agadjanian, Victor; Menjívar, Cecilia; Zotova, Natalya (2017) Legality, Racialization, and Immigrants' Experience of Ethnoracial Harassment in Russia. Soc Probl 64:558-576
Hayford, Sarah R; Agadjanian, Victor (2017) Determined to stop? Longitudinal analysis of the desire to have no more children in rural Mozambique. Popul Stud (Camb) 71:329-344
Dodson, Zan M; Agadjanian, Victor; Driessen, Julia (2017) How to allocate limited healthcare resources: Lessons from the introduction of antiretroviral therapy in rural Mozambique. Appl Geogr 78:45-54
Agadjanian, Victor; Yao, Jing; Hayford, Sarah R (2016) Place, Time and Experience: Barriers to Universalization Of Institutional Child Delivery in Rural Mozambique. Int Perspect Sex Reprod Health 42:21-31
Chae, Sophia; Hayford, Sarah R; Agadjanian, Victor (2016) Father's Migration and Leaving the Parental Home in Rural Mozambique. J Marriage Fam 78:1047-1062
Luz, Luciana; Agadjanian, Victor (2015) Women's decision-making autonomy and children's schooling in rural Mozambique. Demogr Res 32:775-796
Agadjanian, Victor; Hayford, Sarah R; Luz, Luciana et al. (2015) Bridging user and provider perspectives: family planning access and utilization in rural Mozambique. Int J Gynaecol Obstet 130 Suppl 3:E47-51
Yao, Jing; Agadjanian, Victor; Murray, Alan T (2014) Spatial and social inequities in HIV testing utilization in the context of rapid scale-up of HIV/AIDS services in rural Mozambique. Health Place 28:133-41
Yao, Jing; Murray, Alan T; Agadjanian, Victor (2013) A geographical perspective on access to sexual and reproductive health care for women in rural Africa. Soc Sci Med 96:60-8

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