Women in sub-Saharan face a high risk of HIV-1 acquisition during the first year postpartum which can be reduced by antenatal voluntary counseling and testing (VCT) and using female controlled HIV-1 prevention methods. In preventing heterosexual HIV-1 transmission, the success of female controlled methods such as female condoms, the vaginal diaphragm, and vaginal microbicides depends on their use by women at a high risk of HIV-1 infection. In studies of prevention of mother-to-child transmission (PMTCT) little attention has been paid to women identified as HIV-1 negative and their risk of becoming infected after delivery. An understanding of the factors that influence HIV-1 incidence among uninfected mothers, and which female controlled prevention methods are most acceptable to them, is crucial for preventing HIV-1 acquisition in these women, and hence, preventing additional mother-to-child transmission of HIV-1 in future pregnancies. We propose to determine the potential effectiveness of female controlled HIV-1 prevention methods, and the impact of participation in perinatal HIV-1 prevention programs on HIV-1 incidence in the first year after delivery (assessed using a detuned ELISA at 9 to 12 months postpartum) in three sites in Kenya.
The specific aims of the study are to: 1. Determine the correlates of incident HIV-1 infection among Kenyan women in the first year postpartum; 2. Compare the incidence of HIV-1 infection among women who have participated in perinatal HIV-1 prevention programs to the incidence among those who have not participated in these programs; 3. Determine women's knowledge, attitudes, and willingness to use vaginal microbicides, the female diaphragm, and female condoms; 4. Estimate the effectiveness of the various HIV-1 prevention methods based on theoretical efficacy, the number and HIV-1 infection risk of women willing to utilize these methods. This study will provide important information on how to increase the effectiveness of female controlled HIV-1 prevention methods by targeting women at a high risk of acquiring HIV-1 infection. The study will also identify ways to increase the impact of antenatal VCT in reducing HIV-1 incidence.
