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HIV infection is an important risk for maternal and neonatal morbidity and mortality, which can, however, be mitigated by timely initiation of antiretroviral therapy (ART). Prevention of Mother to Child Transmission (PTMCT) and Anti Retroviral Therapy (ART) coverage have increased in the last few years, leading to a decrease in maternal mortality in some countries within sub-Saharan Africa, and to a decrease in new infections. Still, many women in need of medication do not access ART. In addition to failure to access ART, there may be other continued risks of HIV infection during pregnancy, particularly in low resource settings, for behavioural and biological reasons. In sub-Saharan Africa, the high prevalence of HIV infection among pregnant women makes the interaction between HIV and other maternal morbidities an important public health issue. The epidemic has found a wealth of opportunities to thrive in the context of constrained and tragic human conditions, fuelled by poverty, abuse, violence, prejudice and ignorance. This PhD thesis employs a life history approach and gives more insight on sexual risk behaviours and practices of both men and women during pregnancy in urban South Africa. Sexuality is lived and practiced within the context of local sexual cultures. Different cultures and traditions influence behaviour in particular ways, whether or not it is considered acceptable by local norms and traditions. In the context of HIV diagnosis,there is further complications as women try to deal with the new HIV infection, and questions of disclosure, support, intimacy, trust, violence and negotiating safer sex spaces for themselves and their partners. The challenges that exist for both women and men in securing and maintaining long-term relationships, and their fear of loss of current partners, complicate their efforts to address issues of HIV risk and sex in pregnancy. This thesis accentuates the need for policy reforms in South Africa and similar contexts to address the importance of sexual risk behaviours and practices, and to provide support in pregnancy to manage the emotional and personal difficulties during and post pregnancy.

BACKGROUND: Progress in achieving maternal health goals and the rates of reductions in deaths from individual conditions have varied over time and across countries. Assessing whether research priorities in maternal health align with the main causes of mortality, and those factors responsible for inequitable health outcomes, such as health system performance, may help direct future research. The study thus investigated whether the research done in low- and middle-income countries (LMICs) matched the principal causes of maternal deaths in these settings. METHODS: Systematic mapping was done of maternal health interventional research in LMICs from 2000 to 2012. Articles were included on health systems strengthening, health promotion; and on five tracer conditions (haemorrhage, hypertension, malaria, HIV and other sexually transmitted infections (STIs)). Following review of 35,078 titles and abstracts in duplicate, data were extracted from 2292 full-text publications. RESULTS: Over time, the number of publications rose several-fold, especially in 2004-2007, and the range of methods used broadened considerably. More than half the studies were done in sub-Saharan Africa (55.4 %), mostly addressing HIV and malaria. This region had low numbers of publications per hypertension and haemorrhage deaths, though South Asia had even fewer. The proportion of studies set in East Asia Pacific dropped steadily over the period, and in Latin America from 2008 to 2012. By 2008-2012, 39.1 % of articles included health systems components and 30.2 % health promotion. Only 5.4 % of studies assessed maternal STI interventions, diminishing with time. More than a third of haemorrhage research included health systems or health promotion components, double that of HIV research. CONCLUSION: Several mismatches were noted between research publications, and the burden and causes of maternal deaths. This is especially true for South Asia; haemorrhage and hypertension in sub-Saharan Africa; and for STIs worldwide. The large rise in research outputs and range of methods employed indicates a major expansion in the number of researchers and their skills. This bodes well for maternal health if variations in research priorities across settings and topics are corrected.