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

Alexander Moran, Nyiko Mashele, Rufaro Mvududu, Pamina Gorbach, Linda-Gail Bekker, Thomas J Coates, Landon Myer, Dvora Joseph Davey, Alexander Moran, Nyiko Mashele, Rufaro Mvududu, Pamina Gorbach, Linda-Gail Bekker, Thomas J Coates, Landon Myer, Dvora Joseph Davey

Abstract

Pregnant women in sub-Saharan Africa are at high risk of HIV acquisition and require effective methods to prevent HIV. In a cohort of pregnant women offered Pre-exposure prophylaxis (PrEP), we evaluate the relationship between internalized and anticipated stigma and PrEP initiation at first antenatal visit, 3-month continuation and adherence using multivariable logistic regression. High internalized and anticipated PrEP stigma are associated with lower PrEP care initiation at first antenatal visit (aOR internalized stigma = 0.06; 95% CI = 0.03-0.11 and aOR anticipated stigma = 0.55; 95% CI = 0.31-1.00) compared to women with low reported stigma, after controlling for covariates. Women whose partners have not been tested for HIV or whose serostatus remains unknown have 1.6-times odds of PrEP retention at 3-months compared to women whose partners have been tested (aOR = 1.60; 95% CI = 1.02-2.52) after adjusting for covariates. PrEP counseling and maternal PrEP interventions must consider individual- and relational-level interventions to overcome anticipated PrEP stigma and other barriers to PrEP initiation and adherence.

Keywords: HIV prophylaxis; PrEP; Pregnancy; South Africa; Stigma.

Conflict of interest statement

The authors have no conflicts of interest to declare that are relevant to the content of this article.

© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Figures

Fig. 1
Fig. 1
PrEP-PP cohort and analysis sample, 9-September 2020

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