***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Most HIV-1 transmission in Africa occurs among HIV-1-discordant couples ( one partner HIV-1 infected and one uninfected ) who are unaware of their discordant HIV-1 serostatus . Given the high HIV-1 incidence among HIV-1 discordant couples and to assess efficacy of interventions for reducing HIV-1 transmission , HIV-1 discordant couples represent a critical target population for HIV-1 prevention interventions and prevention trials . Substantial regional differences exist in HIV-1 prevalence in Africa , but regional differences in HIV-1 discordance among African couples , has not previously been reported . Methodology /Principal Findings The Partners in Prevention HSV-2/HIV-1 Transmission Trial ( “ Partners HSV-2 Study ” ) , the first large HIV-1 prevention trial in Africa involving HIV-1 discordant couples , completed enrollment in May 2007 . Partners HSV-2 Study recruitment data from 12 sites from East and Southern Africa were used to assess HIV-1 discordance among couples accessing couples HIV-1 counseling and testing , and to correlate with enrollment of HIV-1 discordant couples . HIV-1 discordance at Partners HSV-2 Study sites ranged from 8–31 % of couples tested from the community . Across all study sites and , among all couples with one HIV-1 infected partner , almost half ( 49 % ) of couples were HIV-1 discordant . Site-specific monthly enrollment of HIV-1 discordant couples into the clinical trial was not directly associated with prevalence of HIV-1 discordance , but was modestly correlated with national HIV-1 counseling and testing rates and access to palliative care/basic health care ( r = 0.74 , p = 0.09 ) . Conclusions / Significance HIV-1 discordant couples are a critical target for HIV-1 prevention in Africa . In addition to community prevalence of HIV-1 discordance , national infrastructure for HIV-1 testing and healthcare delivery and effective community outreach strategies impact recruitment of HIV-1 discordant couples into HIV-1 prevention trials Background The reproductive decisions made by PLHIV and their partners have a long-term consequences for the survival and wellbeing of their families and a society at large . Evidence relating to fertility and reproductive intentions among PLHIV is rare , despite the fact that more than 80 % of PLHIV are of reproductive age . The aim of the study was to determine fertility desire and associated factors among PLHIV attending ART clinic in Fitche Hospital . Methods A facility based cross-sectional study design with both quantitative and qualitative data collection methods was employed from February21-April 20th , 2013 . The study participants were selected by using simple r and om sampling technique . A pre- tested structured question naire was used to collect data . Both bivariate and multivariate logistic regressions were used to identify associated factors . Result The prevalence of fertility desire of PLHIV in Fitche Hospital was 133(39.1 % ) with 95 % CI of ( 34.3 % -44.3 % ) . This study identified that factors found to be associated with fertility desire were : - Age from 18 - 29y [ AOR = 3.95 , 95 % CI : 1.69 - 9.22 ) and 30 - 39y ( AOR = 3.91 , 95 % CI : 1.90 -8.19 ) ] , marital length ≤4y [ AOR = 5.49 , 95 % CI : 2.08 - 14.51 ) , within 5 - 9y ( AOR = 4.80 , 95 % CI : 2.14 - 10.78 ) and 10 - 14y ( AOR = 2.82 , 95 % CI : 1.19 -6.63 ] , had not biological living children [ AOR = 11.42 , 95 % CI : 3.27 - 39.90 ) and had more than one child ( AOR = 3.67 , 95 % CI : 1.27 - 10.62 ) ] , community pressure [ AOR = 3.67 , 95 % CI : 1.54 - 8.70 ] , partner fertility [ AOR = 7.18 , 95 % CI : 3.39 - 15.22 ) ] , duration HIV diagnosis≤1y[AOR = 4.99 , 95 % CI : 1.91 - 13.09 ] , disclosed HIV serostatus [ AOR = 3.9 , 95 % CI : 1.37 - 11.10 ] and partner sero-difference [ AOR = 2.05 , 95 % CI : 1.01- 4.15 ] were some of the factors significantly associated with fertility desire . Conclusion The prevalence of fertility desire of PLHIV in the study area was 39.1 % . In this study : - age , marital length , biological child , partner , community pressure , duration of HIV-diagnosis , discordant HIV-test and disclosure of HIV-serostatus to partner were demonstrated to have more associations with fertility desire among PLHIV , therefore , these factors should be emphatically considered during PLHIV 's reproductive health program development HIV care and treatment setting s provide an opportunity to reach people living with HIV/AIDS ( PLHIV ) with prevention messages and services . Population -based surveys in sub-Saharan Africa have identified HIV risk behaviors among PLHIV , yet data are limited regarding HIV risk behaviors of PLHIV in clinical care . This paper describes the baseline sociodemographic , HIV transmission risk behaviors , and clinical data of a study evaluating an HIV prevention intervention package for HIV care and treatment clinics in Africa . The study was a longitudinal group-r and omized trial in 9 intervention clinics and 9 comparison clinics in Kenya , Namibia , and Tanzania ( N = 3538 ) . Baseline participants were mostly female , married , had less than a primary education , and were relatively recently diagnosed with HIV . Fifty-two percent of participants had a partner of negative or unknown status , 24 % were not using condoms consistently , and 11 % reported STI symptoms in the last 6 months  . There were differences in demographic and HIV transmission risk variables by country , indicating the need to consider local context in design ing studies and using caution when generalizing findings across African countries . Baseline data from this study indicate that participants were often engaging in HIV transmission risk behaviors , which supports the need for prevention with PLHIV ( PwP ) . Trial Registration Clinical Trials.gov Introduction Stable heterosexual HIV-1 serodiscordant couples in Africa have high HIV-1 transmission rates and are a critical population for evaluation of new HIV-1 prevention strategies . The Partners PrEP Study is a r and omized , double-blind , placebo-controlled trial of tenofovir and emtricitabine-tenofovir pre-exposure prophylaxis to decrease HIV-1 acquisition within heterosexual HIV-1 serodiscordant couples . We describe the trial design and characteristics of the study cohort . Methods HIV-1 serodiscordant couples , in which the HIV-1 infected partner did not meet national guidelines for initiation of antiretroviral therapy , were enrolled at 9 research sites in Kenya and Ug and a. The HIV-1 susceptible partner was r and omized to daily oral tenofovir , emtricitabine-tenofovir , or matching placebo with monthly follow-up for 24–36 months . Results From July 2008 to November 2010 , 7920 HIV-1 serodiscordant couples were screened and 4758 enrolled . For 62 % ( 2966/4758 ) of enrolled couples , the HIV-1 susceptible partner was male . Median age was 33 years for HIV-1 susceptible and HIV-1 infected partners [ IQR ( 28–40 ) and ( 26–39 ) respectively ] . Most couples ( 98 % ) were married , with a median duration of partnership of 7.0 years ( IQR 3.0–14.0 ) and recent knowledge of their serodiscordant status [ median 0.4 years ( IQR 0.1–2.0 ) ] . During the month prior to enrollment , couples reported a median of 4 sex acts ( IQR 2–8 ) ; 27 % reported unprotected sex and 14 % of male and 1 % of female HIV-1 susceptible partners reported sex with outside partners . Among HIV-1 infected partners , the median plasma HIV-1 level was 3.94 log10 copies/mL ( IQR 3.31–4.53 ) and median CD4 count was 496 cells/µL ( IQR 375–662 ) ; the majority ( 64 % ) had WHO stage 1 HIV-1 disease . Conclusions Couples at high risk of HIV-1 transmission were rapidly recruited into the Partners PrEP Study , the largest efficacy trial of oral PrEP . ( Clinical Trials.gov NCT00557245 OBJECTIVE To survey the attitudes of human immunodeficiency virus (HIV)–serodiscordant couples interested in assisted reproduction  and better characterize their motivations for reproducing . METHODS A prospect ively design ed question naire and open-ended interview of 50 consecutive HIV-serodiscordant couples interested in undergoing assisted reproduction to avoid transmission of virus were studied . Demographic characteristics and attitudes regarding beginning a family were obtained . By design , males were HIV seropositive ( age , 38.0 ± 5.4 years , range 26–51 years ) and healthy . Women were HIV seronegative ( age , 34.5 ± 5.1 years , range 24–45 years ) . Most couples were married ( 44 of 50 ) and in long-term relationships ( duration of relationship , 8.9 ± 4.9 years , range 1–20 years ) . RESULTS Before presentation , nine of 50 couples had conceived and delivered a child ( three of nine instances with knowledge of paternal HIV status ) . Previous timed intercourse occurred in 8 % of couples ( four of 50 ) . Six individuals stated they would proceed with timed intercourse if no other alternatives existed . Forty-eight percent said they would prefer  artificial insemination with donor sperm in lieu , if assisted reproduction failed or were unavailable . Forty-three percent of respondents would pursue “ posthumous conception ” if cryopreserved sperm or embryos were available in the event of the partner 's death . Most couples discussed the possibility of single parenting ( 45 of 50 ; 90 % ) or the possibility for adoptive parenting ( 29 of 50 ; 58 % ) . Couples were aware of risk , and 92 % ( 46 of 50 ) understood that their child might contract HIV . CONCLUSION Human immunodeficiency virus – serodiscordant couples are actively seeking reproductive assistance and often consider or practice unsafe measures to achieve pregnancy . Reproductive issues and concerns unique to these couples need to be addressed before treatment Outlined is our experience with couples in whom the male was both human immunodeficiency virus ( HIV ) seropositive and a haemophiliac who underwent assisted reproductive technologies ( ART ) in order to attain family goals while minimizing the risk of HIV transmission . We report their demographics , attitudes towards assisted reproduction , and ART performance and outcomes . The study included HIV serodiscordant couples ( n = 11 ) who underwent ART at a university-based infertility practice from August 1997 to May 2002 . Prior to treatment , couples prospect ively completed a survey regarding their demographics and attitudes towards assisted reproduction . All couples underwent ART and pregnancy outcomes were analysed . The majority of the patients were fully employed , college-educated , in good health , married and motivated to have a child while minimizing the risk of HIV transmission . Eleven couples underwent 25 cycles of ART [ 19 in vitro fertilization ( IVF ) cycles ; five frozen embryo transfer cycles ; and one oocyte donation cycle ] result ing in nine successful pregnancies . The ongoing/delivered pregnancy rate per initiated IVF cycle was 42.1 % per embryo transfer . Eight of 11 ( 72.7 % ) couples achieved a successful pregnancy . More than half ( six of 11 ; 54.5 % ) the couples conceived during their initial attempt . Four of nine ( 44.4 % ) pregnancies were multiple gestations , including three sets of triplets . All female recipients tested seronegative for HIV at 3 and 6 months post-embryo transfer . All delivered babies ( n = 8) tested seronegative for HIV at birth and 3 months postpartum . Four pregnancies are currently ongoing . ART should be considered for HIV serodiscordant couples with haemophilia who desire to have children in order to minimize the risk of viral infection IMPORTANCE A key factor in assessing the effectiveness and cost-effectiveness of antiretroviral therapy ( ART ) as a prevention strategy is the absolute risk of HIV transmission through condomless sex with suppressed HIV-1 RNA viral load for both anal and vaginal sex . OBJECTIVE To evaluate the rate of within-couple HIV transmission ( heterosexual and men who have sex with men [ MSM ] ) during periods of sex without condoms and when the HIV-positive partner had HIV-1 RNA load less than 200 copies/m 
    Output:
    
The results of this systematic review suggest that many individuals in HIV-serodiscordant relationships have fertility desires/intentions , although the prevalence is particularly heterogeneous in LMIC in comparison to HIC .
Well-known factors such as younger age and a fewer number of living children were consistently associated with increased fertility desires/intentions .