New Study Identifies Key Factors Influencing PrEP Use Among South African Women

A qualitative study from Harvard Global and Harvard Medical School researchers identified the critical influences of pre-exposure prophylaxis (PrEP) uptake and adherence among South African women intending to get pregnant.

Generally, women are at higher risk of getting HIV infection during pregnancy and at its highest during postpartum because many men would have multiple partners during those times. PrEP is an effective and safe way to protect themselves from HIV transmission through sexual intercourse, preventing vertical transmission.

Although PrEP is also safe during pregnancy and is even recommended by the World Health Organization, initiatives to target women during preconception, pregnancy, and postpartum are still in their early phase and are mainly a challenge for women across Africa, where many are living with HIV.

What Is PrEP?

Pre-exposure prophylaxis (PrEP) can reduce the risk of HIV/AIDS infection from sex or injection and is highly effective when taken as prescribed. According to the Centers for Disease Control and Prevention (CDC), PrEPS could be pills or shots taken depending on their risk.

Truvada and Descovy are the two approved pills, while Apretude is the only approved shot. According to CDC, people should consult their doctor if they are thinking of switching from PrEP pills to shots to determine which is best for each patient.

PrEP is safe, although some people may experience side effects, including diarrhea, headache, nausea, fatigue, and stomach pain. They usually go away over time. However, some could be severe or do not go away, so it is best to consult a health care provider.

HIV Vaccine Efficacy Trial Conducted In Uganda

(Photo : Luke Dray/Getty Images)
Sharon Kazoora, aged 28 from Kampala, poses for a portrait on March 16, 2022 in Masaka, Uganda. She has been part of the trial for around a year and said she joined the program because “I fear catching HIV, we grew up in a community with children whose mother had HIV, and they were suffering very much. They didn’t educate, and found it hard to get food.” She added “You know Uganda is not easy, so I needed a vaccine to protect me.”

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Factors Influencing PrEP Use Among South African Women

The Protecting Yourself Before Pregnancy Study or Zivikele Ngaphambi Kokukhulelwa Study (ZINK) was a mixed-methods intervention study that interviewed South African women intending to conceive in the next 12 months.

Its findings were reported in the paper titled "Influences on PrEP Uptake and Adherence Among South African Women During Periconception and Pregnancy: A Qualitative Analysis," published in the journal AIDS and Behavior.

Participants were between 18 to 35 years old, and all had been in a relationship for at least six months with a man with unknown HIV status, AIDS Map reported. They were offered different strategies and each woman had up to the interviews that captured relevant life events.

There were 25 women in the study who were categorized as high adherence (80% or more doses), low adherence(less than 80%), and declined PrEP use. Below are the factors that made South African women in long-distance relationships choose intermittent use of PrEP:

Being away from partners
COVID-19 lockdowns have prevented access to PrEP
Being in different locations every day or traveling for long periods that they forgot to take their medication
Pregnancy and motherhood. Many are worried about PrEP's side effects and forget to take it when the baby is born due to the demands of motherhood.
Fear of stigma on using PrEP, especially from their partners.

Although some may not tell their partners or parents, others opted to inform their close circle, which helped them religiously take PrEP pills. The team hopes their study could encourage PrEP advocates to consider these factors influencing uptake and adherence to PrEP use.