AWH Uganda

When prevention innovation reaches headlines before it reaches clinics, protection can quietly decline. Recently, while reviewing our service data at @ArkWellnessHub found myself asking questions about a drop in PrEP refills and enrolment. Was this pill fatigue? Reduced access to prevention commodities following HIV program funding cuts? That seemed plausible especially since we invest heavily in digital PrEP education, deploy online tools, and ensure that everyone who walks through our doors understands their prevention options. But something else became clear. We have talked loudly and often about injectable PrEP. We’ve celebrated it in conferences, headlines, research updates, and policy conversations. Yet for most people who need it, it is still not accessible. During a staff meeting, I got informed that the team team is receiving increasing calls, messages, and walk-in inquiries about injectable PrEP. Clients in consultation rooms are saying they will start when the injectables arrive. They have seen the news. They have heard Uganda received doses. They know studies were conducted here. But on the ground, injectable PrEP remains largely invisible and unavailable. A dangerous gap is emerging between promise and access and in its naivety, it is real, especially among young people. Expectations are shifting. Many are delaying starting daily pills and current users are not picking their refills. The risk perception is quietly dropping. Injectable PrEP is framed as easier, and yes, it is. It is discreet and offers freedom from daily dosing. All true. But the behavioural effect is complex, just as we have seen before with reduced condom demand among many PrEP users. Creating demand for PrEP among young people is uniquely challenging in our context because younger clients often prefer less daily responsibility, respond strongly to peer and media narratives, and have a lower tolerance for burden. The structural factors still matter; funding cuts affecting supply chains, program scale-downs, stigma, access barriers, and commodity shortages. But the promise of injectable PrEP may be amplifying these challenges. Our message remains clear: DO NOT PAUSE PrEP! Continue protection until injectable options are truly accessible. However, this has placed real pressure on service providers navigating hope, expectations, and reality. As we push for innovation, we must also manage expectations, communicate honestly, and ensure that hope does not unintentionally increase risk. Frontline colleagues, as we work on messaging to counter the “oral PrEP pause” HAS THIS BEEN YOUR EXPERIENCE TOO?