Willingness to Use HIV Pre-exposure Prophylaxis among Community Pharmacy Users in Uganda

In the fight against HIV, a virus that has shaped global health for decades, prevention has long relied on stopping transmission after exposure or treating those already infected. But a powerful tool has emerged to stop the virus before it ever takes hold: pre-exposure prophylaxis, known as PrEP. This is a daily medication taken by people who are not infected but are at risk, acting as a shield that prevents the virus from establishing an infection. While daily pills have proven effective, they require a strict routine that can be difficult to maintain, and for many, the stigma of taking a daily pill for a disease that carries heavy social judgment is a barrier too high to climb. Recently, science has offered a new option: a long-acting injection given only every few months. This shift promises to make protection easier to manage and more private, potentially reaching people who would otherwise go without. Yet, for any medical advance to succeed, it must be accepted by the people it is meant to serve. Understanding who is willing to use these new tools, and where they prefer to receive them, is the critical next step in turning medical possibility into public health reality.

In Uganda, where new HIV infections continue to affect communities disproportionately, researchers turned their attention to a place often overlooked in official health strategies: the community pharmacy. These small, local shops are frequently the first place people go when they feel unwell, offering privacy and quick access without the long waits or formal procedures of government hospitals. A team of scientists from institutions in Uganda, the United States, and Scotland set out to see if these pharmacies could serve as a gateway to PrEP. They recruited nearly five hundred people visiting eighteen different pharmacies in and around Kampala and Wakiso. These visitors were seeking treatment for sexually transmitted infections, emergency contraception, or other common ailments. The researchers tested them for HIV and other infections, and then, for those who were not infected or did not know their status, they asked a simple but vital question: if you were at risk, would you be willing to take PrEP?

The results revealed a landscape of high potential but low awareness. Among the people who were eligible for the study, only about thirty percent had ever heard of PrEP before. This lack of knowledge was striking, especially given that more than half of the participants showed signs of having a sexually transmitted infection, a condition that significantly increases the risk of catching HIV. However, when the study nurses explained what PrEP was and how it worked, the mood shifted dramatically. Almost all of those who had never heard of the medication said they would be willing to use it if they were at risk. This suggests that the barrier is not a refusal to protect oneself, but simply a lack of information. When the researchers introduced the idea of the long-acting injection, which requires a shot only every few months rather than a daily pill, the interest remained strong. More than half of the people willing to use PrEP said they would prefer the injection over the daily tablet.

The study also uncovered who was most eager to try these new methods. Men were more likely than women to express a willingness to use the injectable version. The researchers noted that this might be because men often face unique challenges in seeking healthcare, or because the idea of a long-acting shot feels less burdensome than the daily reminder of a pill. People who reported drinking alcohol or engaging in transactional sex—where sex is exchanged for money or goods—were also significantly more likely to say they would use PrEP. Furthermore, those who were currently experiencing symptoms of a sexually transmitted infection showed a strong interest in the injection. This finding is particularly important because it highlights a natural opportunity: people visiting a pharmacy for an infection could be screened for HIV risk and offered PrEP in the same visit, managing two health needs at once.

When asked where they would prefer to receive this protection, the answers were split between community pharmacies and traditional health facilities, with a slight majority favoring the clinics. However, a significant portion, nearly half, said they would be comfortable receiving the injection right at the pharmacy. This is a crucial detail for the future of HIV prevention in Uganda. It suggests that the existing network of local pharmacies, which are already trusted and accessible, could be expanded to include these life-saving services. By training pharmacists to provide PrEP and the necessary education, health officials could reach people who might never step foot in a government hospital. The study did not test whether this would work in practice, nor did it measure if people would actually stick with the treatment over time. It only measured what people said they would do if the option were available.

The researchers concluded that while the current system has gaps, the willingness to use PrEP is widespread among those at risk. The key to unlocking this potential lies in education and access. If people are informed about the protection available to them, and if that protection can be delivered in a place that feels safe and convenient, the uptake of these tools could rise significantly. The study points toward a future where the fight against HIV is not just fought in large hospitals, but in the quiet, everyday spaces where people already seek help. By meeting people where they are, both physically and in their understanding of the disease, health systems can offer a shield that is not only scientifically effective but also humanly accessible.