<i>After their wives have delivered, a lot of men like going out</i>: Perceptions of HIV transmission risk and support for HIV prevention methods during breastfeeding in sub‐Saharan Africa

Flax, Valerie L.; Hawley, Imogen; Ryan, Julia; Chitukuta, Miria; Mathebula, Florence; Nakalega, Rita; Seyama, Linly; Taulo, Frank; Straten, Ariane van der; Mtn,; Team, Mamma Study

doi:10.1111/mcn.13120

Cited by 6 publications

(5 citation statements)

References 37 publications

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“…Participants recognized their differing perspectives related to the timing and implications of sexual practices during pregnancy and postpartum. In previous publications, we found that HCPs are overwhelmingly a trusted source of advice and guidance for women regarding HIV prevention product use [16,21]. In this study we learned that HCPs are also a trusted source when it comes to decision making around sex during pregnancy and while breastfeeding.…”

Section: Discussionmentioning

confidence: 71%

Sexual Attitudes, Beliefs, Practices, and HIV Risk During Pregnancy and Post-delivery: A Qualitative Study in Malawi, South Africa, Uganda, and Zimbabwe

et al. 2021

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Women who acquire HIV during the pregnancy and breastfeeding periods have a higher risk of transmitting the virus to their child than women who become infected with HIV before pregnancy. We explore the context of sexual beliefs and practices that may shape both HIV risk and willingness to use HIV prevention products during pregnancy and postpartum in Malawi, South Africa, Uganda and Zimbabwe. Twenty-three single sex focus group discussions and 36 in-depth interviews took place between May and November 2018 with recently pregnant or breastfeeding women, men, mothers and mothers-in-law of pregnant or breastfeeding women, and key informants. Participants across study groups and sites (N = 232) reported various perceived benefits and harms of sex during pregnancy and postpartum. Participants discussed reasons why men might seek sex outside of the relationship. There is a critical need for alternative prevention options to protect pregnant and breastfeeding women from HIV.

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Section: Discussionmentioning

confidence: 71%

Sexual Attitudes, Beliefs, Practices, and HIV Risk During Pregnancy and Post-delivery: A Qualitative Study in Malawi, South Africa, Uganda, and Zimbabwe

et al. 2021

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“…Women's perceived need for HIV protection was often motivated by an STI or concerns about partner non‐monogamy. Motivations regarding partner non‐monogamy may be related to expectations of women in this context to abstain from sex leading up to delivery and/or through 6 months postpartum, a time during which men might be expected to seek other sex partners [ 28 , 29 ]. Though women mostly understood PrEP's function, some incorrectly believed that PrEP could treat or prevent STIs and described this as motivating their PrEP use.…”

Section: Discussionmentioning

confidence: 99%

Understanding PrEP decision making among pregnant women in Lilongwe, Malawi: A mixed‐methods study

et al. 2022

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Introduction Pre‐exposure prophylaxis (PrEP) is a promising tool for HIV prevention during pregnancy. With increasing rollout in antenatal settings, counselling strategies to help pregnant women make appropriate decisions about PrEP use are needed. Understanding women's motivations and concerns for PrEP use—and how these inform their decision making and feelings about the decision to start PrEP—are critical to inform these strategies. Methods We conducted a convergent mixed‐methods study from June 2020 to June 2021 in the context of a PrEP adherence support trial among HIV‐negative pregnant women in Lilongwe, Malawi. Two hundred women completed a survey reporting their motivations and concerns about PrEP use, and their feelings about the decision to start PrEP (Decisional Regret Scale). Thirty women completed in‐depth interviews to better understand the decision‐making process, including motivations and concerns weighed in women's decision to use PrEP. Analyses comprised descriptive and bivariate statistics, thematic qualitative analysis, and integration of quantitative and qualitative results. Results Women initiating PrEP during pregnancy were highly motivated to obtain HIV protection for themselves and their unborn child, often due to perceived HIV risk connoted by a recent sexually transmitted infection and/or concerns about partner non‐monogamy. These motivations prevailed despite some concerns about safety and side effects, anticipated stigmatization, and concerns about adherence burden and pill attributes. Many women had informed their partner of their decision to use PrEP yet few felt their decision was contingent upon partner approval. Most women felt positively about the decision to start PrEP (mean decisional regret = 1.2 out of 5), but those with a greater number of concerns reported greater decisional regret (B = 0.036; p = 0.005). Furthermore, women who were specifically concerned about partner disclosure, who disliked pills or who had no perceived HIV risk reported greater decisional regret. Conclusions Pregnant women were strongly motivated by the promise of HIV protection offered by PrEP and accepted it despite diverse concerns. A shared decision‐making approach that centres pregnant women and offers partner involvement may help identify and address initial concerns about PrEP use and support prevention‐effective use of PrEP during this important period.

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“…This often led to tension, particularly when other family members were involved. In another study, a lack of support from male partners in sub-Saharan Africa was vividly portrayed by the fact that “male partners tend to seek outside sexual partners during this period because women need time to recover from delivery, women focus their attention on the child, and some men are disgusted by breast milk” [ 40 ]. This finding was slightly different from the findings in our study, though similarly, some fathers left their women alone to pursue other things like work and drugs.…”

Section: Discussionmentioning

confidence: 99%

“…Participants were primiparous or multiparous HIV-positive women of African descent who had given birth at least once in the previous five years after their HIV diagnosis. Purposive sampling was used, though the final sample size was dependent on achieving saturation [ 40 ]. We aimed to achieve maximum variation [ 37 , 41 ] with respect to social class, as well as the length of time since the migration to Canada or the USA in the case of diasporic participants.…”

Section: Methodsmentioning

confidence: 99%

Male Partners’ Roles in Infant Feeding Practices: Perspectives of Black Mothers Living with HIV in Three Countries

et al. 2022

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Currently, mothers living with HIV (LWH) are challenged with different infant feeding guidelines depending on the country they are living in. This may contribute to confusion, stress, and mental health issues related to decision-making about infant feeding as a mother LWH. Yet, their male partners as their closest social capital have important roles to play in reducing or aggravating this psychosocial distress. Hence, we describe the role of male partners in supporting mothers who are living with HIV in the context of infant feeding. It is based on the results of a recent study of the socio-cultural context of infant feeding among Black mothers LWH in three countries; Canada, the USA, and Nigeria. The study was a tri-national, mixed-methods, community-based participatory research (CBPR) project, informed by postcolonialism and intersectionality theories. This paper is based on the qualitative component of the study. It was a focused ethnography (FE) involving 61 in-depth individual interviews (IDIs) with Black- mothers LWH. Thematic analysis guided the interpretation of these data, and trustworthiness was established through member-checking. Black mothers LWH acknowledged the various support roles that their male partners play in easing the practical and emotional burdens of infant feeding in the context of HIV. Male partners’ roles were captured under three sub-themes: (1) Practical help, (2) Protection of the family, and (3) Emotional support and sounding board. These findings have explicated the evolving ways in which male partners support ACB mothers LWH to promote positive infant feeding outcomes, as well as enhance the emotional and physical well-being of both mother and infant. Our study has explicated the evolving ways in which male partners support Black mothers LWH to promote positive infant feeding outcomes, as well as enhance the emotional and physical well-being of both mother and infant.

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After their wives have delivered, a lot of men like going out: Perceptions of HIV transmission risk and support for HIV prevention methods during breastfeeding in sub‐Saharan Africa

Cited by 6 publications

References 37 publications

Sexual Attitudes, Beliefs, Practices, and HIV Risk During Pregnancy and Post-delivery: A Qualitative Study in Malawi, South Africa, Uganda, and Zimbabwe

Sexual Attitudes, Beliefs, Practices, and HIV Risk During Pregnancy and Post-delivery: A Qualitative Study in Malawi, South Africa, Uganda, and Zimbabwe

Understanding PrEP decision making among pregnant women in Lilongwe, Malawi: A mixed‐methods study

Male Partners’ Roles in Infant Feeding Practices: Perspectives of Black Mothers Living with HIV in Three Countries

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