Empowering Women’s PrEP Choices
Qualitative Insights into Long-Acting PrEP Preferences and Decision-Making during Pregnancy and Breastfeeding in South Africa and Botswana
Bibliographic Data
Pregnant and breastfeeding women (PBW) are at heightened risk of HIV acquisition. We aimed to explore PBW's preferences of various long-acting PrEP modalities. In-depth interviews were conducted with PBW at three sites: Cape Town, East London (South Africa), and Gaborone (Botswana). We conducted thematic analysis, guided by the Health Belief Model, to examine participants' HIV risk perception during pregnancy and breastfeeding, their perceived individual-level facilitators and barriers of each PrEP modality, and the support needed by participants for PrEP uptake and continuation. 40 participants were interviewed, aged 18-39 years (mean 27 years), including 13 adolescent girls and young women (AGYW; 18-24 years). Participants were either pregnant (n = 20) or breastfeeding (n = 20). Perceived HIV risk during pregnancy motivated PrEP use. Long-acting methods were preferred over daily pills for convenience and perceived reliability, with injectables most favoured due to familiarity with contraceptive injections. However, concerns about pain and side effects persisted. Monthly oral PrEP was seen as easier than daily pills but raised similar concerns about adherence. Implants were met with fear and mistrust, often rooted in negative contraceptive experiences, though some valued their long-term protection. The vaginal ring was least acceptable due to unfamiliarity and discomfort with insertion. Participants emphasised the importance of external support (e.g. reminders), privacy and discretion, and community transparency to support PrEP adherence and reduce stigma. Addressing barriers - especially concerns about the safety and effectiveness of new modalities and challenges around adherence - could help improve strategies to better assist PBW in utilising long-acting PrEP modalities
Breastfeeding · Family medicine · Human immunodeficiency virus (HIV · Pill · Pre-exposure prophylaxis · Pregnancy · Qualitative research · Thematic analysis · Adolescent Sexual and Reproductive Health · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Medicine · Nursing · Pediatrics
The Teenage Brain
The influence of HIV‐related stigma on PrEP disclosure and adherence among adolescent girls and young women in HPTN 082
The Health Belief Model and Preventive Health Behavior
Interventions to increase the uptake and continuation of pre-exposure prophylaxis (PrEP) by adolescent girls and young women at high risk of HIV in low-income and middle-income countries
The pre-exposure prophylaxis (PrEP) consciousness of black college women and the perceived hesitancy of public health institutions to curtail HIV in black women
Stepped care to optimize pre-exposure prophylaxis (PrEP) effectiveness in pregnant and postpartum women (SCOPE-PP) in South Africa
Stigma in the health clinic and implications for PrEP access and use by adolescent girls and young women
I had Made the Decision, and No One was Going to Stop Me” —Facilitators of PrEP Adherence During Pregnancy and Postpartum in Cape Town, South Africa
Preferences for Long-Acting PrEP Products Among Women and Girls
Sexual Attitudes, Beliefs, Practices, and HIV Risk During Pregnancy and Post-delivery
Preference for Service Delivery for Long-Acting Pre-exposure Prophylaxis for HIV Infection Among Pregnant and Breastfeeding Women in South Africa and Botswana
Factors influencing adolescent girls and young women’s uptake of community-based PrEP services following home-based HIV testing in Eastern Cape, South Africa
Barriers to Oral HIV Pre-exposure Prophylaxis (PrEP) Adherence Among Pregnant and Post-partum Women from Cape Town, South Africa
The PrEP Journey
Using thematic analysis in psychology
| Unique citing works | 3 |
|---|---|
| Citations per year | 3 |
| Citation span | 2025 - 2026 (2) |
| Citation velocity | current |
| Highly cited | No |
| Citation types | Neutral: 3 |