[Reproductive health and AIDS in sub-Saharan Africa: stakes and challenges]

This literature review assesses knowledge and research regarding consequences of the AIDS epidemic for sexuality and reproductive health in sub-Saharan Africa. The family and social context of AIDS in Africa is first described and consequences of the epidemic for sexual relations between couples and fertility are discussed. The final section analyzes interactions between AIDS prevention and family planning and reproductive health programs. Topics requiring research are identified throughout. The emphasis on high risk sex behavior has deflected attention from the risk of sexual relations within families. Aspects of African family organization that should be studied for their relationship to HIV transmission include polygamy postpartum sexual abstinence the increasing frequency of female headed households and extramarital sexual activity and the high prevalence of sexually transmitted diseases. Little research has been done on sexual relations within stable couples in the context of AIDS or in couples in which one partner is known to be infected. Research is needed on the interaction of HIV infection and fertility in order to define programs integrating AIDS prevention family planning and maternal-child health. Collaboration between reproductive health and AIDS prevention programs in urgently needed but nearly nonexistent and the ideal modalities of such programs remain unclear.