Exploring sexual minority men's perspectives and benefits of long-acting injectable antiretroviral therapy in South Africa.

In South Africa, sexual minority men (SMM) face high HIV rates and challenges with antiretroviral therapy (ART) adherence, hindering viral suppression. Factors, such as non-disclosure, stigma, and partner dynamics, complicate adherence. Long-acting ART options, like injectables, could help address these challenges; however, their acceptability among SMM in South Africa remains unclear. Between April and June 2024, qualitative interviews were conducted with 21 SMM who participated in the Speaking Out & Allying Relationships (SOAR) a video- and skills-based HIV intervention, supporting SMM's communication and coping skills for status-sharing and treatment adherence in South Africa, to explore their initial impressions of injectable ART. Interviews explored disclosure, adherence, partner dynamics, and attitudes toward injectable ART. Participants viewed injectables as a major improvement over daily pills, citing benefits, such as reduced mental burden and increased privacy and safety. They felt that injectables could give them more control over disclosure, and flexibility to manage treatment during social interactions. These findings suggest that long-acting ART could improve adherence and reduce stigma, aligning with SMMs dynamic lifestyle. Further research is necessary to evaluate the effectiveness and accessibility of injectable ART for SMM in South Africa, emphasizing supportive healthcare systems and training providers in this emerging treatment landscape.Abbreviations: ART: antiretroviral therapy; SMM: sexual minority men; U = U: undetectable = untransmittable (HIV campaigns and messaging).