For women facing HIV risk, PrEP offers protection through pregnancy, breastfeeding

For pregnant or breastfeeding women, the fear of contracting HIV can be particularly burdensome. There is concern not only about her own health but also about what an HIV infection could mean for the child she is carrying or nursing.

For women who face a risk of HIV exposure, pre-exposure prophylaxis (PrEP) offers an additional tool for preventing HIV. The medicine is available in oral and injectable forms, although access to some newer formulations remains limited as Nigeria expands its PrEP programme.

Comfort Amina Ochigbo, a prevention programme lead at the Institute of Human Virology Nigeria (IHVN), said women at risk of HIV can use daily oral PrEP during pregnancy and breastfeeding under Nigeria’s national guidelines.

“Oral PrEP is safe in pregnancy and breastfeeding,” Ochigbo said, stressing that women must take the medication every day as prescribed for it to be effective.

For some women, the need for protection may become particularly clear when their partner is living with HIV. Ochigbo said an HIV-negative pregnant or breastfeeding woman whose partner is HIV-positive can benefit from oral PrEP as part of efforts to remain HIV-negative.

But pregnancy can also affect the choice of PrEP formulation.

Ochigbo explained that Nigeria’s national guidance does not provide for injectable PrEP for pregnant women in the same way as oral PrEP.

So, a woman who was already receiving injectable PrEP before becoming pregnant can discuss her options with a healthcare provider and, depending on her circumstances, may continue or switch to oral PrEP.

Pregnant and breastfeeding women need to take oral PrEP every day for it to be effective. But they do not need to change their diets simply because they are taking PrEP.

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However, taking PrEP requires testing and follow-up. People taking oral PrEP should have their HIV status checked every three months, Ochigbo said.

Before starting PrEP, healthcare providers conduct a baseline assessment, including an evaluation of kidney function and creatinine levels where there are concerns about kidney health. Other medicines a woman is taking may also need to be considered.

Hepatitis B also requires careful medical assessment. Ochigbo said having hepatitis B does not automatically exclude a woman from PrEP. Rather, a qualified healthcare provider should assess her individual circumstances and weigh the risks and benefits.

Uchechi Nzenwata, a senior nursing officer with the National AIDS, Viral Hepatitis and STIs Control Programme (NASCAP), Federal Ministry of Health, also said pregnancy is an important consideration when choosing a PrEP option.

Nzenwata said available options include oral PrEP and long-acting injectable PrEP, while lenacapavir is among newer prevention options being introduced. However, she said lenacapavir remains in the pilot phase in Nigeria and is not routinely provided to pregnant women.

“For pregnant women, we do prefer them to go for oral PrEP. Oral PrEP is good,” Nzenwata said.

She said healthcare providers should explain the available options and support clients to make informed decisions.

“Your healthcare provider will explain and counsel you, and you make an informed choice. Nobody will choose for you,” she said.

Nzenwata said women using contraceptives can also access and use PrEP.

“There is no problem if you’re on contraception; it will not hinder you from taking or accessing PrEP,” she said.

She explained that contraception does not prevent a woman from taking PrEP, while PrEP itself does not prevent pregnancy. Women can therefore use both, subject to appropriate counselling and healthcare.

Nzenwata said the national guideline specifies 18 years and above for women seeking PrEP.

“It’s for 18 years. From 18 years and above from the national guideline,” she said.

Kareem, a programme officer with the National Agency for the Control of AIDS (NACA), said PrEP is available to people who meet the eligibility requirements regardless of age or gender, with being HIV-negative a key requirement.

“There’s no age or gender limitation,” he said.

Kareem added that eligible clients can choose their preferred PrEP method and are not required to switch from oral medication to an injectable option.

“If I want to be on the oral PrEP and I don’t want the injectables, I have the right to make a choice,” he said.

Kareem said daily oral PrEP remains the first-choice option among the methods currently available in Nigeria.

“The oral PrEP, which is taken daily, is the first choice for PrEP options,” he said.

He said Nigeria also has longer-acting options, including an injectable one administered every two months and a newer injectable taken every six months.

The six-monthly option is currently being piloted in eight states, and more than 54 per cent of its target in these states has already been reached as at the end of September.

He said the newer injectable being introduced through a pilot programme is not currently available to pregnant women, breastfeeding mothers or people taking hormonal medicines under Nigeria’s current guidelines.

Kareem said eligible people at risk of HIV can access free oral PrEP at HIV service facilities nationwide. Some accredited pharmacies and private hospitals providing HIV services also offer it.

Ochigbo said efforts are also underway to widen access through community outreach and pharmacies. For a woman who is pregnant or thinks she may be pregnant and knows she is at risk of HIV, she advised linking with health facilities that provide HIV services, where oral PrEP can be made available.

Ochigbo rejects the idea that giving women access to PrEP encourages promiscuity. Instead, she describes it as a risk-based prevention service that gives women greater control over protecting themselves from HIV.

Empowering a woman to prevent HIV during pregnancy and breastfeeding can also help protect the child she is carrying or nursing from the consequences of HIV infection, she added.

As Nigeria expands its range of HIV prevention options, the officials emphasised counselling, testing and clinical assessment to help eligible people choose a method appropriate to their circumstances.

For women facing the possibility of HIV exposure during pregnancy or breastfeeding, PrEP offers another way to protect their health—and potentially that of their children.