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



Pregnant and breastfeeding (P/BF) women are at high risk of HIV acquisition due to biological and behavioural factors and need better prevention options. Uptake of new prevention products may be impacted by beliefs and practices during these periods. The MTN-041/MAMMA study explored the hypothetical acceptability of a vaginal ring and oral pre-exposure prophylaxis (PrEP) use during pregnancy and breastfeeding in Sub-Saharan Africa. We explored pregnancy beliefs and practices and how they may impact future HIV prevention product use.


23 Focus Group Discussions (FGDs) and 36 In-depth interviews (IDIs) were conducted among 226 participants in Malawi (N=51), South Africa (N=47), Uganda (N=68) and Zimbabwe (N=60). Participants included P/BF women aged 18-40 (median age 26), men aged 18+ with P/BF partners (median age 30), grandmothers aged 18+ (median age 49) and key informants aged 18+ (median age 50). FGDs and IDIs were conducted in local languages, transcribed, coded using Dedoose software (v7.0.23) and analysed using a socio-ecological framework. Data analysis was done by comparing and contrasting data across sites and study groups.


Across sites, participants in all study groups described that pregnant women perform cultural practices to promote their health and the health of the unborn baby, ease birthing process and for spiritual guidance. Most participants admitted engaging in these practices. Additionally, women often register for antenatal care for detection of pregnancy abnormalities. Birth preparation practices for opening the birth canal include inserting fingers, herbs, drinking herbal mixtures and birth canal lubricants like okra. Pregnant women consult traditional healers and prophets because they are believed to deal with bad spells that cause prolonged labour, caesarean section and abnormal babies. Participants believed that birth canal opening practices could cause ring expulsion, while herbal interaction with HIV prevention drugs could harm both mother and baby. Seeking care from traditional healers and spiritual leaders could impact product use since some are against use of medications.


Cultural beliefs and practices during pregnancy may impact decision making around HIV prevention product use. As such, community roll out of prevention methods needs to be accompanied by education that takes these beliefs and practices into account to encourage uptake.