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Incident HIV in Pregnant Women and Sexual Risk Behaviors Related to Transmission in Urban South Africa

English title Incident HIV in Pregnant Women and Sexual Risk Behaviors Related to Transmission in Urban South Africa
Applicant Merten Sonja
Number 149816
Funding scheme Interdisciplinary projects
Research institution Department of Epidemiology and Public Health Swiss Tropical and Public Health Institute Universität Basel
Institution of higher education University of Basel - BS
Main discipline Infectious Diseases
Start/End 01.11.2013 - 31.10.2017
Approved amount 382'229.00
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All Disciplines (2)

Infectious Diseases
Health Education

Keywords (6)

gender; acute HIV infection; sexual behavior; social cohesion; pregnancy; HIV/AIDS

Lay Summary (German)

HIV-Infektionen während der Schwangerschaft: Soziale und gender-spezifische Risiken
Lay summary

Hintergrund: Wenn eine HIV Infektion während der Schwangerschaft erworben wird, birgt dies besondere Risiken für Mutter und Kind. Die frisch aufgetretene Infektion wird mit einem der üblichen HIV-Schnelltests möglicherweise nicht erkannt, da noch nicht genügend Antikörper gebildet wurden, und eine medikamentöse Prävention der Übertragung des Virus auf das Kind wird somit nicht rechtzeitig eingeleitet. Insgesamt ist das Risiko für eine Übertragung auf das ungeborene Kind bei Frauen, die während der Schwangerschaft eine neue HIV Infektion aufweisen, gegenüber bereits länger seropositiven Schwangeren erhöht.  

Die Frage, ob sich Frauen während der Schwangerschaft öfter mit HIV anstecken, ist noch nicht abschliessend geklärt. Gewisse Verhaltensänderungen während der Schwangerschaft, wie zum Beispiel ein Verzicht auf Kondome, veränderte Intimhygiene, oder auch biologische Veränderungen sind mögliche Risiken. Wenig bekannt ist auch, ob sich das Risikoverhalten bei Männern während der Schwangerschaft der Partnerin ändert, insbesondere wenn Mehrfachbeziehungen bei Männern sozial akzeptiert sind. 

Ziele: Diese interdisziplinäre Studie soll mögliche Verhaltensänderungen während der Schwangerschaft in einem urbanen Kontext in Südafrika erforschen, die sich auf das HIV-Infektionsrisiko auswirken können. Dazu werden Schwangere, die im Chris Hani Baragwanath Hospital in Johannesburg zur Schwangerschaftsvorsorge kommen, und ihre Partner befragt. Verhaltensspezifische Risiken während der Schwangerschaft werden verglichen zwischen neu HIV positiven Frauen und nicht-infiszierten Frauen sowie deren Partner.

Direct link to Lay Summary Last update: 09.10.2013

Responsible applicant and co-applicants



Single in Sowet
MlotshwaLangelihle, MertenSonja (2020), Single in Sowet, in Manderson Lenore, Mkhwanazi Nolwazi (ed.), HRSC Press, Cape Town, 36-38.
Personal support and expressions of care for pregnant women in Soweto, South Africa: a qualitative study
Mlotshwa Langelihle, Manderson Lenore, Merten Sonja (2017), Personal support and expressions of care for pregnant women in Soweto, South Africa: a qualitative study, in Global Health Action, 10(1), 1363454.
Talking about sex in pregnancy: Reflections from the field in urban South Africa
Mlotshwa Langelihle, Manderson Lenore, Chasela Charles, Merten Sonja, Talking about sex in pregnancy: Reflections from the field in urban South Africa, in Culture, Health and Sexuality, 20(1), 1-14.


Group / person Country
Types of collaboration
School of Public Health, Wits University South Africa (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
- Exchange of personnel

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Health wellbeing and Families of care workshop Talk given at a conference Personal support and expressions of care for pregnant women in Soweto, South Africa: 09.04.2015 Wits University, South Africa Mlotshwa Langelihle;


Title Date Place
Panel at Swiss Ethnological Society annual conference 11.11.2015 Bern, Switzerland


Background: HIV incidence during pregnancy may be elevated, compromising the health of both pregnant woman and her child. Risk of mother to child transmission (MTCM) of HIV is increased approximately three fold with early HIV infection (EHI) due to the high viral load prior to sero-conversion. Understanding the magnitude of early HIV infection and risk factors for HIV acquisition and transmission during pregnancy will help to target behavioral interventions. Though antiretroviral drugs are currently available for both treatment and /or prophylaxis in South Africa, current protocols often miss newly incident infection in pregnancy increasing the risk of neonatal infection, and also risking the health of the mother and her sexual partner(s). The interdisciplinary approach to the study will not only help in identification of EHI and also to help to understand the HIV-risk perception, and biomedical, social and cultural determinants in this high risk population.Aims and objectives: The overall aim of the study is to determine early HIV infection among pregnant women who consult the Chris Hani Baragwanath Hospital in Johannesburg for antenatal care, and to understand their biological and sexual risk behaviors and that of their partners. The study will be conducted in two phases and consists of a formative phase and prospective study. The current proposal comprises the formative phase. The main objectives of this study will be to (i)detect early HIV in pregnant women using specimen pooling and HIV RNA PCR tests; (ii)compare sexual risk behavior including intravaginal practices before HIV diagnosis between pregnant women who acquire HIV during pregnancy compared to risk-set matched women without HIV; (iii)compare sexual risk behaviors during pregnancy between male partners of women who acquire HIV during pregnancy and male partners of women without HIV; (iv)understand sexual behavior during pregnancy of women and their partners who acquire HIV during pregnancy, in comparison with women and partners without HIV. The second phase, which is not part of this proposal, will determine HIV incidence in pregnancy and validate the findings from the suggested behavioral studies prospectively. Methods of investigation: Multiple methods will be used to address the four objectives. In a cross sectional design, we will identify women with new infections using specimen pooling and HIV RNA reverse transcriptase polymerase reaction (RT PCR) tests (i). Women diagnosed with early HIV infection at first antenatal visit in the Chris Hani Baragwanath Hospital, Johannesburg, will be enrolled as cases in a case control study (ii). Four aged matched controls for each case will be selected among women who are HIV negative at the time of a case diagnosis. Sexual risk behavior data will be collected to those who choose to join the study enquiring about the six weeks and three months prior to their HIV diagnosis. Partners of women enrolled in the case control study will be invited to enroll in a case control partner study (iii). We will collect data on basic demographics, HIV status and partners’ sexual risk behaviors in the six weeks and three months prior to the HIV diagnosis of their partners. In addition, biographical in-depth qualitative interviews will be conducted with a subsample of cases and controls (iv). This study will be nested within the infrastructure of an ongoing fetal growth study, a developmental pathway study, which will follow up women and their infants up to 42 months after delivery at DPHRU-Chris Hani Baragwanath research site in Johannesburg. The preliminary analysis will inform the development of structured questions/tools for the prospective study design, which is planned to follow 15 months later (separate funding). Significance: The prevalence of HIV among pregnant women in South Africa is estimated at 30%, one of the highest in Sub-Saharan Africa. Among the 24 highest prevalence countries, South Africa is one of the five countries where the burden of HIV is still increasing. There is unmet need for family planning, high incidence of pregnancy, and high HIV transmission rates among women of reproductive age. With the wide availability of antiretroviral drugs it is imperative to optimize identification of HIV infected women for treatment/prophylaxis to prevent transmission to their infants. Although this information is widely available, there is need for an in-depth understanding of the driving forces behind the sexual risk behavior that continue to put pregnant women, their partners and children at risk to help mitigate the problem. Knowing which sexual risk behaviors lead to transmission will facilitate more effective outreach and behavioral interventions.