Qualitative studies on this topic, including one performed in Kenya in 2009, revealed that the desire for children among people living with HIV is motivated by societal expectations, a strong personal wish to experience parenthood, and the belief that children signify hope and a reason for living [21–23]. A qualitative study of serodiscordant couples in Zambia found that the desire for children was one of the primary barriers to the use of condoms within the couple [24]. In summary, the desire to have children can co-exist with HIV infection and discordant relationships. The Kenya AIDS Indicator Survey implemented in 2007 found

that over 40% of HIV-infected individuals have HIV-uninfected regular partners [25]. The desire to see more have children may put the HIV-uninfected partners in discordant relationships at increased risk of HIV acquisition. We analysed data for HIV-discordant couples collected as part of the Partners in Prevention HSV/HIV Transmission Study to determine the magnitude of their risk of HIV transmission relative to whether HDAC inhibitor review or not they conceived during study follow-up. The Partners in Prevention HSV/HIV Transmission Study was a randomized,

placebo-controlled clinical trial of acyclovir for herpes simplex virus (HSV)-2 suppression to reduce HIV-1 transmission in HIV-discordant couples. Couples were enrolled in 14 sites in East and Southern Africa. The study protocol has been described in detail elsewhere [26]. Briefly, HIV-discordant couples were recruited through community HIV counselling and testing sites and local HIV clinics, and were referred to the study site for screening. Couples were eligible for enrolment if they were sexually active (defined as vaginal or anal intercourse at least three times in the last 3 months), were able to provide independent informed consent for participation in the study, planned to remain in the relationship for the duration of

study follow-up (maximum 24 months), and provided locator information. Couples were ineligible if either partner was co-enrolled in another HIV-1 prevention or treatment trial, if the HIV-1-infected woman was pregnant based on self-report DNA ligase or urine testing at enrolment, or if the HIV-1-infected partner had a CD4 count <250 cells/μL, had a history of AIDS-defining diagnoses by World Health Organization (WHO) criteria or was on ART at the time of enrolment [26]. The University of Washington and the Kenya Medical Research Institute Ethical Review Committees and the University of California San Francisco Committee on Human Research approved the protocol. All participants provided written informed consent prior to enrolment. All index partners were HIV-1 antibody and HSV-2 antibody positive.