HIV status, fertility intentions, and sexual risk reduction intentions among couple voluntary counseling and testing participants in Ethiopia

Objective. This dissertation investigates the composition of couple voluntary counseling and testing (VCT) clients in Ethiopia and how HIV diagnosis is associated with fertility intentions and sexual risk reduction intentions.;Methods. Data come from the Ethiopia Voluntary Counseling and Testing Integrated with Contraceptive Services Study. This dissertation focuses on the couple VCT sample, which included over 1,200 participants. Multilevel logistic regression compared the characteristics of sexually active individual VCT participants in partnerships to sexually experienced couple VCT participants and compared sexually experienced couple VCT participants to those who had never had sex. Then, the association between the HIV status of the couple and ceasing to desire children between pre-test and post-test counseling was examined with logistic regression. Finally, multinomial regression was used to examine the association between a couple's HIV status and changing sexual risk reduction intentions between pre- and post-test.;Results. The odds of attending couple versus individual VCT for sexually active participants in partnerships were significantly lower among women (aOR=0.56, p<0.001), those in longer relationships (aOR=0.97, p=0.03), and those who believed they were at risk for HIV/AIDS (aOR=0.62, p<0.001), and they were higher among premarital testers (aOR=26.58, p<0.001). Sexually experienced couple VCT participants were less likely to have attended school (aOR=0.20, p<0.001) or be premarital testers (aOR=0.11, p<0.001) as those who had never had sex. Women who belonged to serodiscordant couples in which the male (aOR=6.55, p=0.02) or female (aOR=8.29, p=0.001) was HIV+ were more likely to stop desiring children than women in HIV-concordant relationships. No such relationship was found among men. Individuals who belonged to serodiscordant couples (aOR=7.43, p<0.001 if male HIV+ and aOR=5.96, p<0.001 if female HIV+) or HIV+ concordant couples (aOR=4.34, p=0.01) were more likely to have increased versus unchanged sexual risk reduction intentions than individuals in HIV-couples.;Conclusions. Sexually experienced individual VCT clients in partnerships have different socio-demographic characteristics than their couple VCT counterparts. Serodiscordance was associated with no longer desiring children among women and increased abstinence and condom intentions among men and women attending couple counseling, indicating the need for couple VCT to discuss condoms and other forms of contraception.