Male partner involvement in pregnant and breastfeeding women's use of pre-exposure prophylaxis (PrEP) in a low-income setting in South Africa.

HIV in South Africa remains highly gendered, with women experiencing nearly twice the burden of men. Pregnant and breastfeeding women (PBFW) face elevated HIV acquisition risk, and incident maternal HIV infection during these periods increases the likelihood of vertical HIV transmission. Male partners play a critical role in supporting PBFW to initiate and persist on oral pre-exposure prophylaxis (PrEP), yet limited evidence exists on how best to foster partner support. We conducted in-depth interviews with male partners of PBFW enrolled in a randomized trial (SCOPE-PP) that offered real-time biofeedback counselling on PrEP adherence and access to HIV self-testing (HIVST) in both study arms. Eligible male partners of participants in the intervention arm were invited to participate in November-December 2024. A thematic approach explored men's perceptions of and support for their partners' PrEP use. We completed sixteen interviews. Median relationship length was six years; four partners were married to the index participant. All PBFW were taking PrEP at the time of the interview. Men generally held positive views of PrEP, describing it as protective for both mother and infant. Many provided emotional encouragement or practical support. Open communication helped resolve initial mistrust or gendered assumptions that women's PrEP use signaled suspicion of male infidelity. Exposure to PrEP also prompted men to reflect on their own HIV prevention needs. Findings underscore the value of approaches that center communication within couples to strengthen disclosure and male engagement in PrEP uptake and adherence during the perinatal period and to promote shared responsibility for HIV prevention within families.