Male partners’ support and influence on pregnant women’s oral PrEP use and adherence in Malawi

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  • Young A.M.
    • Affiliation: Gillings School of Global Public Health, Department of Maternal and Child Health
  • Saidi F.
    • Affiliation: School of Medicine, Department of Obstetrics and Gynecology
  • Phanga T.
    • Affiliation: School of Medicine, UNC Project-Malawi
  • Tseka J.
    • Affiliation: School of Medicine, UNC Project-Malawi
  • Bula A.
    • Affiliation: School of Medicine, UNC Project-Malawi
  • Mmodzi P.
    • Affiliation: School of Medicine, UNC Project-Malawi
  • Pearce L.D.
    • Affiliation: College of Arts and Sciences, Department of Sociology
  • Maman S.
    • Affiliation: Gillings School of Global Public Health, Department of Health Behavior
  • Golin C.E.
    • Affiliation: Gillings School of Global Public Health, Department of Health Behavior
  • Mutale W.
    • Other Affiliation: University of Zambia
  • Chi B.H.
    • Affiliation: School of Medicine, Department of Obstetrics and Gynecology
  • Hill L.M.
    • Affiliation: Gillings School of Global Public Health, Department of Health Behavior
Abstract
  • Introduction: Daily oral pre-exposure prophylaxis (PrEP) is a safe and effective HIV prevention method for pregnant and postpartum women, but adherence barriers exist. Understanding the role of male partners in supporting PrEP use may inform strategies to support PrEP adherence among pregnant and breastfeeding women. Methods: To understand male partners’ involvement in women's use of PrEP, we conducted in-depth interviews with pregnant women in Lilongwe, Malawi who had recently decided to use PrEP (n = 30) and their male partners (n = 20) in the context of a PrEP adherence trial. Women were purposively recruited to ensure variation in their partners’ HIV status. Interviews were conducted in Chichewa using a semistructured guide. We followed a thematic approach to analyze the interview data. Results: Most male partners were receptive to women using PrEP during pregnancy because it eased their fears of the woman and baby acquiring HIV. Men often played a key role in women's PrEP adherence by providing daily reminders and encouragement to adhere to their medication. The majority of women appreciated this support from the men as it lessened the burden of remembering to take their medications daily on their own and aided their adherence. However, several women who lacked male partner support spoke of wanting their partners to be more involved. Many men living with HIV found the mutual support beneficial for their antiretroviral therapy adherence, while men without HIV or with status unknown appreciated knowing that the family was protected. While most men were open to women continuing PrEP beyond the current study, some would only support it if women were still at risk for acquiring HIV. Conclusion: In this study, male partners were strongly motivated to support the PrEP adherence of their female partners as a way of ensuring that the pregnant women and unborn babies were protected against HIV. Promoting disclosure and tangible support that arises organically among men may be helpful, but programs to enhance this support and identify ways to support women who do not receive support from their partners or do not wish to disclose their PrEP use to partners may be needed. 2023 Young, Saidi, Phanga, Tseka, Bula, Mmodzi, Pearce, Maman, Golin, Mutale, Chi and Hill.
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  • Article
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  • Attribution 4.0 International
Journal title
  • Frontiers in Reproductive Health
Journal volume
  • 5
Language
  • English
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  • LH and CG report grant support from Gilead Sciences. This does not alter our adherence to journal policies on sharing data and materials. The authors otherwise have declared that no competing interests exist.
  • This study was funded by the National Institute of Mental Health (K01 MH121186) and the National Institute of Allergy and Infectious Diseases (R01 AI131060). Additional investigator and administrative support is provided by NIAID (K24 AI120796, P30 AI050410) and Fogarty International Center (D43 TW009340, D43 TW010060). Funders were not involved in the study design development, writing of the protocol, and in the decision to submit this article for publication.
ISSN
  • 2673-3153
Publisher
  • Frontiers Media SA

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