HIV, Pregnancy, Breastfeeding, and Contraception in African Women: Barriers and Facilitators to Pre-Exposure Prophylaxis Uptake and Adherence.

Abstract This paper explores the barriers and facilitators influencing the uptake and adherence to pre-exposure prophylaxis (PrEP) among pregnant and postpartum women, highlighting its critical role in preventing maternal HIV acquisition and vertical transmission. Drawing from recent literature, the study synthesizes evidence on socio-cultural, behavioural, and health system determinants that shape women's engagement with PrEP services. Findings indicate that while PrEP is safe and effective in reducing HIV transmission risks, adherence is often hindered by stigma, side effects, limited partner support, and healthcare delivery gaps. Conversely, factors such as perceived HIV risk, partner encouragement, and counselling support promote consistent use. The review underscores the need for integrated service delivery models, provider training, and community-based interventions that address contextual barriers. Emphasis is placed on the potential of long-acting injectable PrEP and the integration of HIV prevention into maternal and child health services as strategies to improve adherence. Ultimately, this study advocates for a holistic, women-centred approach to HIV prevention that aligns biomedical interventions with social and structural enablers to achieve optimal maternal and infant health outcomes in Africa.