Department of Biostatistics and Epidemiology, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America.
PLoS One. 2018 May 14;13(5):e0197143. doi: 10.1371/journal.pone.0197143. eCollection 2018.
HIV acquisition during pregnancy and breastfeeding significantly contributes toward paediatric HIV infection; however, little is known about risk behaviours in HIV-uninfected pregnant and postpartum women. We conducted twenty-six in-depth-interviews between July and December 2016 using a semi-structured interview guide among HIV-uninfected pregnant and recently postpartum women at-risk of HIV acquisition (defined as reporting ≥1 of the following: partner's serostatus unknown or HIV-infected, recent condomless sex in pregnancy, and/or alcohol use during pregnancy) who attended primary healthcare services. Our study contextualizes factors related to risky sexual behaviours during pregnancy and postpartum periods and assesses knowledge and hypothetical acceptability of pre-exposure prophylaxis (PrEP) in pregnancy. Translated and transcribed data were coded and analysed by three researchers using a thematic analysis approach. In interviews with HIV-uninfected pregnant/postpartum women at-risk of HIV acquisition, we identified common themes associated with sexual risk behaviours during pregnancy, including: lack of control over decisions in sex and condom use in pregnancy, low perceived risk (e.g. beliefs that their partner has the same HIV-negative serostatus), and socio-cultural beliefs around condom use during pregnancy (e.g. contact with sperm is essential for baby's development). PrEP knowledge was low among HIV-uninfected pregnant and breastfeeding women, and potential acceptability was good, though primary concerns were around the potential impact on the infant. While mothers presented a clear desire to protect themselves from HIV acquisition once pregnant, they also reported lack of control, and socio-cultural beliefs, like sex is good for the baby, that increased their risk of seroconversion. Mothers had limited PrEP awareness but reported hypothetical willingness to use PrEP because of concerns over HIV acquisition and onward mother to child transmission.
艾滋病毒在妊娠和哺乳期的传播是导致儿童感染艾滋病毒的重要原因;然而,对于未感染艾滋病毒的孕妇和产后妇女的感染风险行为知之甚少。我们在 2016 年 7 月至 12 月期间,对有感染艾滋病毒风险的未感染艾滋病毒的孕妇和刚分娩的妇女(定义为报告以下至少 1 项:伴侣的血清状况未知或艾滋病毒感染、怀孕期无保护性行为、以及/或怀孕期间饮酒)进行了 26 次深入访谈,这些妇女在初级保健服务机构就诊。我们的研究将与怀孕和产后期间危险性行为相关的因素进行了背景化,并评估了怀孕期使用暴露前预防(PrEP)的知识和假设可接受性。翻译和转录的数据由 3 位研究人员使用主题分析方法进行编码和分析。在对有感染艾滋病毒风险的未感染艾滋病毒的孕妇/产后妇女的访谈中,我们确定了与怀孕期间性行为风险相关的常见主题,包括:在怀孕期间对性行为和使用避孕套的决策缺乏控制、低风险感知(例如,相信其伴侣具有相同的 HIV 阴性血清状况),以及围绕怀孕期间使用避孕套的社会文化信念(例如,接触精液对婴儿的发育至关重要)。未感染艾滋病毒的孕妇和哺乳期妇女对 PrEP 的了解程度较低,但潜在的接受度较好,尽管主要关注的是对婴儿的潜在影响。虽然母亲在怀孕后明确表示希望保护自己免受艾滋病毒感染,但她们也报告说缺乏控制,以及社会文化信念,例如性对婴儿有益,这增加了她们血清转化的风险。母亲对 PrEP 的认识有限,但报告了假设的使用意愿,因为担心感染艾滋病毒和母婴传播。