Educating Pregnant and Breastfeeding Mothers to Make Informed HIV Preventive Choices

Expectant mothers have a lot to think about. For some, this can include protecting their unborn child from HIV. In Zambia, USAID DISCOVER-Health offers pregnant and breastfeeding women access to pre-exposure prophylaxis, the HIV preventive option more commonly known as PrEP.

In 2018, USAID DISCOVER-Health worked with partners to roll out PrEP, a daily antiretroviral pill that can reduce a person’s risk of HIV by over 90 percent. While people who have HIV are on treatment permanently, people who use PrEP do so only while at risk of HIV.

The project gives pregnant women HIV information when they visit clinics for antenatal services. This is the case at Kakulu Health Center in the Kapiri Mposhi District in Zambia’s Central Province, where Mutinta Siadunka provides PrEP. She explains the success of this integrated service delivery model. “It’s common for people to come for one service, like antenatal, and then we tell them about other services. Some people know what PrEP is, but most don’t. So I explain it so they can understand and accept it as a good HIV preventive option.”

Some women have concerns about taking the drug. “With pregnant and breastfeeding mothers, some of them are nervous,” says Mutinta. “They worry and ask, ‘will this cause any damage to my child?’ I explain that the drug has no effect on the child. It’s important these women understand that before they start taking it.”

Across all sites in fiscal year 2021 (FY21, October 2020–September 2021), the project initiated 3,263 eligible and accepting pregnant and breastfeeding women on PrEP, an increase of 3,174 over the same period in 2019–2020. Of all pregnant and breastfeeding women on PrEP in PEPFAR programs in Zambia in FY21, 39 percent are DISCOVER-Health clients. The project encourages women on PrEP to use other methods, such as condoms, as additional protection from HIV.

For discordant couples, in which one person is HIV-negative and the other is positive, DISCOVER-Health encourages the HIV-positive partner to start antiretroviral treatment immediately and adhere to it. The project also explains the importance of viral load suppression to help keep both partners safe. Ruth is a 34-year-old mother of four who visited Kakulu in December 2018 to access antenatal services. The project counseled her on HIV testing, and both she and her husband returned to test together. “I came out negative, but my husband was HIV-positive,” says Ruth. “We had a conversation with the clinician, where we heard about PrEP. I wanted to do what I could to protect myself. My husband was supportive and also wanted me to protect myself.” Ruth has continued PrEP. “PrEP is good for me and makes me feel safe. I’m encouraging other women to visit the clinic, take the advice and get protected. My baby boy is doing well and I will stay on PrEP to be healthy for my family.”

Young mothers and pregnant adolescent girls and young women often require the approval of partners and other family members when it comes to health decisions, so a PrEP-supportive family and community environment is critically important. Masoso Chisala, a community mobilization officer in Kapiri Mposhi, and his team build community understanding and acceptance of PrEP to make it easier for women to access the service. Masoso and other community mobilization officers also make sure that community health workers have PrEP knowledge. Masoso is confident that this strategy will continue to increase the number of pregnant and breastfeeding women on PrEP.

I am a strong believer in that where people lack knowledge, they perish. I want to be part of that story, where these women get the knowledge they need and they then have the power to make positive decisions.”