Risk perception and sex behaviour in pregnancy and breastfeeding in high HIV prevalence settings: Programmatic implications for PrEP delivery

Abstract

HIV acquisition during pregnancy and breastfeeding significantly contributes toward paediatric HIV infection; however, little is known about risk behaviours in HIV-uninfected pregnant and postpartum women. We conducted twenty-six in-depth-interviews between July and December 2016 using a semi-structured interview guide among HIV-uninfected pregnant and recently postpartum women at-risk of HIV acquisition (defined as reporting ≥1 of the following: partner’s serostatus unknown or HIV-infected, recent condomless sex in pregnancy, and/or alcohol use during pregnancy) who attended primary healthcare services. Our study contextualizes factors related to risky sexual behaviours during pregnancy and postpartum periods and assesses knowledge and hypothetical acceptability of pre-exposure prophylaxis (PrEP) in pregnancy. Translated and transcribed data were coded and analysed by three researchers using a thematic analysis approach. In interviews with HIV-uninfected pregnant/postpartum women at-risk of HIV acquisition, we identified common themes associated with sexual risk behaviours during pregnancy, including: lack of control over decisions in sex and condom use in pregnancy, low perceived risk (e.g. beliefs that their partner has the same HIV-negative serostatus), and socio-cultural beliefs around condom use during pregnancy (e.g. contact with sperm is essential for baby’s development). PrEP knowledge was low among HIV-uninfected pregnant and breastfeeding women, and potential acceptability was good, though primary concerns were around the potential impact on the infant. While mothers presented a clear desire to protect themselves from HIV acquisition once pregnant, they also reported lack of control, and socio-cultural beliefs, like sex is good for the baby, that increased their risk of seroconversion. Mothers had limited PrEP awareness but reported hypothetical willingness to use PrEP because of concerns over HIV acquisition and onward mother to child transmission.

The landscape for HIV pre-exposure prophylaxis during pregnancy and breastfeeding in Malawi and Zambia: A qualitative study

“…Despite these favorable opinions, the reported concerns among respondents require consideration, particularly in the design of future programs. For example, concerns about potential harm to mother and infant echo findings from other studies in the region [4, 32, 33]. Similar to other settings [30, 34], the need for near-perfect adherence raised concerns and participants worried about the consequences of HIV transmission in the context of poor PrEP adherence.…”

Modelling the potential impact of providing preexposure prophylaxis in pregnant and breastfeeding women in South Africa

“…There is a dearth of data on PrEP uptake and adherence in pregnant/breastfeeding women [9,19]. A recent study in pregnant and postpartum SA women found that there was a high potential interest in PrEP during pregnancy, though baseline knowledge was low [36].…”

Maternal PrEP Use in HIV-Uninfected Pregnant Women in South Africa: Role of Stigma in PrEP Initiation, Retention and Adherence

“…We examined crude associations between possible confounders (gestational age at baseline, education level, gravidity, partner HIV testing, STI at baseline), exposures (internalized PrEP stigma and anticipated PrEP stigma) and outcomes of interest ((1) PrEP care initiation at baseline, (2) PrEP care retention at three months, (3) PrEP care continuation at three months and (4) Self-reported PrEP adherence at three months) in separate models using logistic regression. We chose these variables based on formative research on PrEP use among pregnant women in South Africa [ 5 , 6 ]. We considered exact logistic regression but did not find significant differences in the results.…”