Table 2.

Anticipated benefits and concerns with ring and pill use, overall and during pregnancy and breastfeeding periods, with representative quotes

Vaginal ring
Benefit
Long acting/ease of use	it is like a tampon, so I don’t think it can interfere. Even the tampon is worse because it gets full and you can feel it is full but the vaginal ring stays there for a month so I don t think it can interfere with your life. [Lisa, 27, woman, Johannesburg
Discreet/private	People will say, “Ah, what are these pills for?” and they can actually say that you have HIV. The ring is discreet. If husbands are not cooperative, women can just use it as long as it will not be felt during sex [Tanatswa, 25, woman, Chitungwiza]
Local drug exposure	Since it was explained that the ring protects only the vaginal part so I don’t think it’s going to have an effect on the child while breastfeeding because the medicine doesn’t go up to the breasts it only settles on the vagina. [Ngwanenyana, 26, woman, Johannesburg]
Concern
Interference with sex	What I worry about is for it (ring) to make the woman less lubricated. It can even torture me psychologically because I know that there is something in the woman’s vagina. I may fail to enjoy sex with this woman having the ring. [Emma, 23, man, Uganda]
Vaginal insertion taboo	It is not allowed for a pregnant woman to be inserting the ring in the vagina because when a woman is pregnant there are many problems or I should say that so many happenings in the same vagina… I should say that she cannot be busy having time to take care of the ring…[Chikondi, 30, man, Blantyre]
Vagina enlarged/overloaded	Already as I progress in pregnancy the vagina will be enlarging and with this [Ring] now, what will the sex partners say? They will not enjoy sex. [Jane, 30, woman, Chitungwiza]
Baby entangled or injured during delivery	What if I am at home and have labour pains and deliver there, it [vagina ring] will strangle the baby, how will the baby come out? the baby must come through that tube, yes it will interfere. It will block the baby, cause of infections and all that, and hurt the baby because you would have forgotten because labour pain will be heavy on you. [Nonhlanhla, 34, woman, Johannesburg]
Misperceived as abortion tool a	They [HCPs] will ask you if you want to abort the baby, that’s another thing, they will ask what is it, do you want to abort? [India, 31, woman, Johannesburg]
Exacerbates physical discomfort of pregnancy	Because you are uncomfortable already about everything, your body changes more often, the baby is moving and so on, so your thoughts are filled with what if I am going to labor and maybe I push this thing [the ring] hard and it disturbs the baby, you have got all those things in your head so yeah you won’t be comfortable throughout. [Apple, 24, woman, Johannesburg]
Problem inserting/removing ring	What I fear about it…I feel it is big and hard. Can I really insert such a thing? You are telling us that we remove it ourselves but how do I do that? [Vanessa, 23, Woman, Kampala]
May affect milk production	My question is about breastfeeding women, won’t it [vaginal ring] have some side effects like…you know some family planning methods affect breastfeeding mothers and they can’t have enough breast milk…so my question is, won’t breastfeeding mothers lose breast milk? [Suzan, 29, woman, Uganda]

Oral pills
Benefit
Pill familiarity	I don’t think it will be difficult for us to take this pill, or it will not be difficult for me because I use oral contraceptive pills (Jane, 30, woman, Chitungwiza)
Protection from multiple sexual routes a	These pills can help for both oral and vaginal sex because there are those who prefer oral sex to vaginal sex. [Grey, 26, woman, Johannesburg]
Tested and approved	As something that was tested and seen that we can use it, I do not think it will be difficult when we are taught and we understand. I do not foresee any problems for us to use it because it was already tested by doctors and they saw it fit for us to use it.” [Tendai, 37, woman, Chitungwiza]
Oral medication may benefit the fetus or baby	I am siding with [Makhosi] because we do take pills while we are pregnant like the vitamins and they tell you it is for blood or high blood pressure, so this one will be treated the same, for high blood [pressure] to protect the child and make the baby grow, so there will be no worries. [Nonhlanhla, 34, woman, Johannesburg]
Concern
Pills are for sick people	The worry I have is that I hear people saying that when a person takes drugs when she is not sick, it causes poison in her body. I don’t know if it is true or not. Now, won’t it [PrEP] cause our loved ones (wives) to get poison in their bodies and then we start seeking treatment for poison? [Farouk, 54, man, Uganda]
Mistrust in relationships	I doubt they [men] would agree and want their partners to use it. For them it would be questionable, how do you use such a product knowing that it’s just me and you… it would be like undermining their manhood because, [..] you can always go outside [cheat] [Mastermind, 29, man, Johannesburg]
Oral pills taboo	…yes it is good that the drugs [pills] will protect from HIV, but they may bring some undesirable side effects while you are pregnant; as it is said that when one is pregnant, she should not be taking drugs.[Lucy, 29, woman, Blantyre]
Forgetfulness with daily dosing	Taking that tablet every day during pregnancy helps to prevent HIV but you can forget to take it and have engage into sex with a man and when you test you find yourself infected with HIV. [Sharon, 19, woman, Kampala]
Poor health effects of bitter drugs	People believe that when a woman is pregnant taking bitter things affect the baby that can result in the death of the unborn baby and these bitter things can be prohibited in the community. [Unite, 28, woman, Blantyre]
Exacerbate nausea and other symptoms	I would [starting on PrEP] after two months when the baby has grown otherwise during those early days pregnancies are so delicate. That is when a woman vomits a lot and tablets also have their side effects…I think it should be started after four months.[Esther, 22, woman, Uganda]
Risk of miscarriages during first trimester	I would think that it is better to start taking it when at least the womb is about three months. I think tablets might affect it and end up with a miscarriage if you take them at one week or a month. [Suzan, 29, woman, Uganda]
Potent drug may disable baby	The first thing I think about is whether it won’t affect the baby because you have told us that we can take it during pregnancy but won’t it affect the baby and probably deliver when is disabled? [Agatha, 21, woman, Uganda]
Compatibility with traditional medicine	I think it is important to tell the traditional healer you are using the ring or pill, imagine she will give you that concoction to drink and it will take away the effectiveness of the pill [India, 31, woman, Johannesburg]
Side effects and drug interaction with hormones	As a pregnant mother, what first comes into my mind is the issue of side effects to me and the baby, because just like any other pill there are side effects. The other thing is, since my hormones are already tempered around with because of pregnancy, will the PrEP pill go down well with me? [Tanya, 31, woman, Chitungwiza]
Increased appetite	I think that tablet might increase a woman’s appetite yet she doesn’t have what to eat and she is pregnant. [Barbra, 36, woman, Uganda]
Drying up milk	In as much as I want to prevent myself from HIV, the other thing that comes into my mind is what is going to happen if they dry up my milk, yet I am supposed to do exclusive breast feeding in the first 6 months. [Tanya, 31, woman, Chitungwiza]
Milk contamination	I will be worried that maybe the breastmilk will be bitter. [Mpho, 27, woman, Johannesburg]
HIV stigma	After delivery, you go to your parents’ home to nurse the baby and there are pills that you need to take at a certain time [..].Always at 8 p.m. you must take it. That’s when they will gossip about you and suspect that you are positive, “why is she not telling us?” you see! [Nonhlanhla, 34, woman, Johannesburg]

PrEP, pre‐exposure prophylaxis.

^aMinority view in Johannesburg.