What encourages – and discourages – women who are trying to get pregnant from adhering to PrEP?

Interviews with South African women who were offered PrEP when trying to get pregnant suggests being away from partners, having mobile lives, and HIV-related stigma can disrupt adherence. But being open about PrEP with a partner can help.

What is the research about?

PrEP use among women who are planning to get pregnant. Researchers interviewed 25 women (ages 19-33) in eThekwini, which includes Durban and the surrounding areas.

Why is this research important?

When a couple tries to conceive it can increase HIV risk, as it means having sex without a condom.

Women in South Africa already have a higher risk of getting HIV than men. As PrEP is safe for women to take when they are pregnant, or planning to get pregnant, it is important to understand what might encourage (and discourage) women in this situation to use it.

What did they find out?

Most women felt they were at high risk of getting HIV as they suspected their partner was unfaithful or he would not test for HIV. This led many to take PrEP – to protect their health and the health of a potential unborn child.

But other women did not want to take PrEP. Reasons for this included:

• concerns about the effects of PrEP on a pregnancy
• fear of side effects
• worries that PrEP would react badly with alcohol
• preferring to use other HIV prevention methods
• worries about taking PrEP every day.

A number of things influenced how well women who were taking PrEP adhered to it.

Being away from partners

None of the women lived with their partners. Some were separated by long distances, especially when men worked away. Some women stopped taking PrEP when they were away from their partners, then started again when they saw them.

Mobile lifestyles

Many of the women lived in Durban but often visited rural family homes. Long visits to male partners or family members within Durban were also common. Some women left PrEP at home, so they stopped taking it while they were away.

Stigma

Some women worried that their partner (and others) would think they had HIV or were being unfaithful if they knew they took PrEP so they did not tell them. This made it difficult to take PrEP every day.

Women who told their partner (and others) they were using PrEP found it easier to take their pills every day.

Presenting PrEP as one of a number of safer conception strategies often got a positive response from partners, as they were likely to approve of anything that increased the chances of having a healthy child.

What does this mean for HIV services?

Women should take PrEP daily for at least seven days before and after possible exposure to HIV. And if someone has possibly been exposed to HIV they should not take PrEP again before getting tested. It is very important that any PrEP support provided to women who are trying to conceive includes this information. Particularly as women may be using ‘stop-start’ PrEP strategies due to long-distance relationships and mobile lifestyles.

Supporting women to come up with strategies to remind them to take PrEP with them when they travel is also important, as is ensuring they have enough PrEP while they are away.

Providing couples with communications skills-building could help more women feel able to tell their partner about taking PrEP. Combining this skills-building with accurate information about PrEP could also help to reduce misconceptions and stigma.