“PrEP protects us”: Behavioural, normative, and control beliefs influencing pre-exposure prophylaxis uptake among pregnant and breastfeeding women in Zambia

Abstract

BackgroundAlthough pre-exposure prophylaxis (PrEP) is recommended for pregnant and breastfeeding women at elevated HIV risk, uptake has been low in Zambia.MethodsIn in-depth interviews, we explored beliefs about PrEP among 24 HIV-negative pregnant and breastfeeding Zambian women. Thematic analysis was used to identify behavioural, normative and control beliefs likely to influence PrEP uptake.ResultsMost women viewed PrEP as a good method of protecting themselves and their babies from HIV infection. Partners were cited as key referents in decision making about PrEP use. Many women felt that PrEP use was not entirely in their control. Most reported that they would not use PrEP if their partners did not approve. Health care providers with negative attitudes, long distance to clinics, and extended waiting times were cited as barriers to PrEP uptake.ConclusionHIV-negative pregnant and breastfeeding women had a positive attitude towards PrEP but barriers to uptake are multifaceted.

Uptake of and intention to use oral pre-exposure prophylaxis for HIV among pregnant and post-natal women in Eswatini: a cross-sectional survey

“…The factors associated with PrEP use identified by this study included having a known HIV-positive male partner, a male partner with unknown HIV status, positive attitudes towards PrEP, high self-efficacy, having tested for an STI in the last 6 months, and having taken PEP in the last 6 months. This finding aligns with previous studies conducted in Zambia and Kenya among PPW where factors associated with PrEP use were: being a sero-different couple, having a partner of unknown HIV status, having a positive attitude towards PrEP ( 47 ), and a reactive syphilis test result ( 7 ). Some studies identified other pertinent factors for PrEP use such as: engaging in sex without a condom in the past six months, having experienced intimate partner violence ( 7 , 29 ), the desire to safely conceive a child ( 23 ), being a drug injector, being homeless ( 48 ) and rape ( 29 ).…”

“…Our study found other reasons for PrEP discontinuation including; unavailability of PrEP and being stopped by partner or husband. Consistent findings from regional studies reported PrEP stock-outs and needing partner or husband approval to take PrEP as barriers to PrEP uptake, adherence and retention ( 23 , 39 , 47 ). The lack of autonomy among women to make decisions concerning their health may present a barrier to PrEP uptake.…”

Barriers and facilitators to uptake and persistence on prep among key populations in Southern Province, Zambia: a thematic analysis

“…By contrast, other studies with MSM have described uncertainty over a partner’s sexual relationships with others as facilitating their PrEP use [ 30 , 34 ]. Relationship-related barriers served as among the reasons given for recommendations that PrEP be offered as an injectable, so that PrEP could be used with more discretion, a finding noted in other qualitative studies on PrEP preferences among different PP groups in Zambia [ 40 , 48 , 49 ]. That said, some studies have described the benefits of PrEP-use disclosure to intimate partners for adherence and stigma-management [ 50 ], though this comes with fear of violence [ 51 ].…”

Knowledge and attitude to HIV pre exposure prophylaxis among women in five sub-Saharan African countries: a multilevel model analysis of population-based survey 2021–2022

“…Their knowledge and positive attitudes toward PrEP can influence its acceptance and uptake among pregnant women [ 53 , 54 ]. Furthermore, integration of HIV services into maternal health settings has been shown to improve the uptake and retention of services related to prevention of mother-to-child transmission (PMTCT) [ 55 , 56 ]. This integration can lead to increased awareness and acceptance of HIV prevention strategies including PrEP.…”