“It is a better option, but we need to see it work”: Perceived benefits, concerns and implementation requirements for long-acting injectable HIV treatment and prevention in Uganda

For millions of people living with HIV, daily life involves a quiet, persistent ritual: taking a pill at the same time every day. This medication, known as antiretroviral therapy, keeps the virus under control and prevents it from damaging the immune system. For prevention, a similar daily pill can stop the virus from taking hold in the first place. While these oral medicines are life-saving, they come with a hidden weight. They require a person to remember to take them, to carry them in a pocket or bag, and to find a private moment to swallow them. In many places, the simple act of opening a pill bottle can reveal a person's status to a partner, a coworker, or a stranger, leading to fear, shame, or rejection. Scientists and doctors have been working on a different kind of solution: long-acting injectable medicines. These are shots given by a healthcare worker that stay in the body for weeks or months, offering protection or treatment without the need for daily pills. The idea is that by moving from a daily routine to a periodic visit, people might find it easier to stay healthy and keep their privacy.

Researchers in Uganda recently set out to understand how people would actually feel about switching to these injections. They did not just ask if the idea sounded good; they listened to the real worries, hopes, and practical concerns of people living with HIV, those using prevention pills, and the doctors and nurses who would have to give the shots. The study took place in two different health centers, one a government facility serving a busy urban area and the other a specialized hospital. The team spoke with thirty-six patients in group discussions and ten healthcare workers in private interviews. They wanted to know what would make someone choose an injection over a pill, and what would make them say no. The goal was to see if the promise of fewer daily reminders could overcome the new challenges of relying on scheduled clinic visits.

The people who spoke to the researchers described a daily struggle that goes beyond simply remembering to take medicine. For many, the pill bottle itself is a source of anxiety. One man explained that the sound of tablets rattling inside a tin container could be heard in a crowded taxi, drawing suspicious glances from strangers. Others worried that taking medicine at a specific time would force them to leave a meeting or a classroom, revealing their status to friends or colleagues. For those who travel for work or live in shared housing, carrying a supply of pills can be a logistical nightmare. The idea of an injection offered a sense of relief. Participants imagined a life where they did not have to hide a bottle in a drawer or rush to find a bathroom to swallow a pill. They saw the shot as a way to travel freely without the fear of running out of medicine or being asked to explain why they were taking something.

However, the enthusiasm for this new option was not unconditional. The researchers found that people were cautious, and their willingness to switch depended heavily on trust and safety. A major concern was the permanence of the injection. With a daily pill, if a person feels sick or has a bad reaction, they can simply stop taking it. With a long-acting shot, the medicine is already inside the body, and there is no way to remove it. Participants worried about what would happen if they developed a side effect they could not control. They asked for clear proof that the injections were safe and effective, especially regarding fertility and long-term health. Many said they would wait until they saw others in their community using the product without problems before they tried it themselves. The fear of pain was also real; people worried about the needle itself, the soreness at the injection site, and the privacy of having their body exposed during the procedure.

The desire for the injection also varied depending on who the person was and where they lived. Younger people, particularly students, seemed more interested in the idea because daily pills interfered with their school schedules and social lives. They wanted to avoid the stigma of being seen with medication. Older adults, who had been stable on daily pills for years, were often more hesitant to change a routine that worked for them. Gender played a role as well; some women expressed a strong need for privacy to avoid conflict with partners who might not know their status, while others worried about how the injections might affect their ability to have children. For people with jobs, the trade-off was complex. While an injection meant they did not have to take medicine at work, it meant they had to leave work to visit the clinic every few months. Some feared that missing a scheduled appointment would leave them unprotected, whereas a daily pill offered a safety net of their own making.

The healthcare workers who were interviewed shared these concerns and added their own perspective on what would be needed to make the system work. They knew that for the injections to succeed, the clinics would need to be ready. This meant having enough staff trained to give the shots safely and to answer difficult questions about side effects. It meant having a reliable supply of the medicine so that patients would not arrive at the clinic only to find the shelves empty. The workers also emphasized the need for a system to remind patients when their next appointment was due, perhaps through a phone call or a text message, and a clear plan for what to do if someone missed a visit. Without these supports, the risk of people falling out of care would be high. The researchers noted that the success of these injections would not depend solely on the science of the drug, but on the reliability of the health system delivering it.

Ultimately, the study revealed that the decision to use long-acting injectable HIV treatment or prevention is not a simple choice between a pill and a shot. It is a complex calculation involving personal privacy, the fear of side effects, the convenience of travel, and the trust in the medical system. The people in Uganda did not reject the idea of injections; in fact, they saw clear benefits in reducing the daily burden of medication and protecting their secrets. But they made it clear that this benefit comes with a price: a dependence on the clinic schedule and the certainty that the medicine will be there when needed. The researchers concluded that for these injections to become a reality, health programs must do more than just offer the product. They must build a system that is trustworthy, flexible, and ready to handle the specific fears and needs of the people it serves. The path forward requires listening to these concerns, preparing the clinics, and ensuring that the choice to switch is supported by a network of care that does not break down.