BACKGROUND:
Access to effective HIV prevention strategies, such as PrEP in antenatal and postnatal care periods presents an opportunity to curtail both HIV incidence among women of reproductive age and vertical transmission of HIV. We explored knowledge of, access to, willingness and intention to use oral and injectable PrEP among pregnant and post-partum women aged 15-49 years in South Africa.

METHODS:
We conducted once-off in-depth interviews (IDIs) with 59 pregnant and breastfeeding women aged 15-49 who were attending antenatal care services at public health facilities across three purposefully selected districts. Audio-recordings of IDIs were transcribed and translated into English. An iterative analytical process was used, in which interview data was coded thematically, and underwent team interpretation.

RESULTS:
Women expressed limited knowledge about PrEP, and among those who knew about PrEP the majority had never been offered PrEP before. Among those who had been offered PrEP, some refused it due to various reasons including disliking pills, not wanting to take a daily medication, insufficient knowledge about PrEP, stigma and fear of being judged of using HIV medication, challenges with access to the health facilities to get PrEP and not being sexually active. Women who were currently taking PrEP shared enablers and motivations for them to use PrEP, such as wanting to protect themselves and the baby, and support from peers and partners to use PrEP.

CONCLUSIONS:
These findings demonstrate that lack of knowledge and information about PrEP, PrEP stigma, and dislike of daily pill-taking, are barriers affecting oral PrEP uptake among pregnant and breastfeeding women. There is a need to improve women’s knowledge and awareness about PrEP to help dispel the myths and misinformation about PrEP. Strengthening enablers of PrEP uptake is necessary to improve uptake and prevent HIV infection during pregnancy and breastfeeding for both the woman and her child.