Pre-Exposure Prophylaxis to prevent HIV infection during Pregnancy and Breastfeeding: A South African Perspective

HIV infection represents a global catastrophe. Despite the availability of highly active antiretroviral drugs, new HIV infections continue to be reported worldwide. The pandemic impacts Eastern and Southern African Countries more than any other part of the world, with South Africa taking center stage. Pregnant and breastfeeding women, together with adolescent girls and young women, are a particularly vulnerable population group. The prevention of primary HIV infection provides an opportunity for the eradication of HIV perinatal transmissions, as espoused by WHO. Great strides have been made over the past decade, with more options for pre-exposure prophylaxis having being made available to individuals at risk of HIV acquisition. Some of these products are critical, as they empower women to take control of their own sexual health choices. As a result of ethical considerations, pregnant and lactating women have largely been excluded from pivotal trials on pre-exposure prophylaxis. There are limited data on the available options for prevention of new HIV infections during pregnancy and lactation. Pregnant and breastfeeding women must be considered in on-going and planned trials, as frameworks for safe and ethical inclusion have already been pioneered. There is lack of awareness and poor uptake of pre-exposure prophylaxis, especially among target populations.