Community beliefs and practices during pregnancy and their potential effect on HIV prevention product use in Sub-Saharan Africa

Abstract

Pregnant and breastfeeding (P/BF) women face a heightened risk of HIV acquisition and need effective HIV 
prevention methods. The MTN-041 study explored the potential acceptability of the dapivirine vaginal ring, 
and oral pre-exposure prophylaxis pills use during pregnancy and breastfeeding in Malawi, South Africa, 
Uganda, and Zimbabwe. We explored pregnancy-related practices and beliefs and their potential impact on 
the use of the ring and pills. Focus group discussions were conducted with P/BF women, grandmothers, 
male partners, as well as in-depth interviews with key informants. Results revealed that P/BF women 
engaged in birth preparation practices and consulted traditional/spiritual healers, traditional birth attendants 
and religious leaders, to promote their health, the health of the unborn baby, to ease the birthing process, 
and sought spiritual guidance. Participants believed these cultural beliefs and practices could have a 
potential effect on uptake of the ring and pills during the pregnancy and breastfeeding periods. Therefore, 
when implementing community roll-out strategies, it is imperative to take these practices into consideration 
to foster increased uptake. These insights can help tailor interventions and public health strategies to better 
meet the unique needs of P/BF women in the fight against HIV.