ORIGINAL RESEARCH article
Front. Reprod. Health
Sec. HIV and STIs
Volume 7 - 2025 | doi: 10.3389/frph.2025.1540248
HIV risk perception and associated factors among pregnant and breastfeeding women in Zambia: Implications for PrEP uptake in antenatal and postnatal settings
Provisionally accepted- 1Department of Population Studies and Global Health, School of Public Health, University of Zambia, Lusaka, Zambia
- 2Department of Health Systems Management and Policy, School of Public Health, University of Zambia, Lusaka, Zambia
- 3Department of Obstetrics and Gynecology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- 4Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
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HIV risk perception is seen as a key motivation for individuals to use biomedical HIV prevention interventions, including pre-exposure prophylaxis (PrEP). We determined HIV risk perception and associated factors among pregnant and breastfeeding women in Lusaka, Zambia.We conducted a cross sectional study among pregnant and breastfeeding women not living with HIV in a hospital setting in Lusaka, Zambia. Study team members administered a structured questionnaire to pregnant and breastfeeding women at the hospital's maternal and child health clinic to get information on socio-demographics, obstetrics and pregnancy history, sexual behavior and HIV risk perception. Participants assessed their HIV risk perception (outcome variable) as no, low, moderate, or high; these were later collapsed into a binary variable of lower vs. higher risk. Logistic regression analysis was used to determine factors associated with high HIV self-risk perception.From September to December 2021, we recruited 389 pregnant and breastfeeding women in our study. Of these, 172 (44%) were pregnant and 217 (56%) were breastfeeding. Most participants were aged between 25-34 years 181 (47%), and the majority 338 (87%) never used a condom with their regular sexual partner. About 129 (33%) of participants perceived higher HIV risk. This appeared higher in breastfeeding vs. pregnant women (40% vs. 25%).Over half (52%) of participants with unknown partner HIV status and one-third (33%) of those who never used condoms with their regular sexual partners perceived higher HIV risk. In adjusted models, higher HIV self-risk perception was associated with breastfeeding status (AOR=1.82; 95%CI: 1.14-2.91), having more than 5 lifetime sexual partners (AOR=4.27; 95%CI: 1.84-9.90), and having a partner of unknown HIV status (AOR=2.15; 95%CI: 1.22-3.78).A low proportion of women perceived higher HIV risk, even when their sexual behaviours and partner characteristics would suggest HIV exposure. HIV prevention programs should focus on the accurate assessment of HIV risk to improve uptake of PrEP in the study population.
Keywords: HIV, PrEP, Risk Perception, Zambia, pregnant, breastfeeding, sub-Saharan Africa
Received: 05 Dec 2024; Accepted: 07 Aug 2025.
Copyright: © 2025 Hamoonga, Mutale, Hampanda and Chi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Twaambo Euphemia Hamoonga, Department of Population Studies and Global Health, School of Public Health, University of Zambia, Lusaka, 50110, Zambia
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