HIV risk perception and associated factors among pregnant and breastfeeding women in Zambia: implications for PrEP uptake in antenatal and postnatal settings

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 and 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.