There’s a growing list of reasons why different people living with HIV are switching to long-acting injectable therapy to manage the virus.

Some switch because it’s more discreet than taking and storing pills to treat HIV. That’s particularly advantageous for folks who aren’t out about their status to their family or roommates. And since switching maintains their undetectable viral load, they cannot transmit HIV via sex.

Other than mild pain at the injection site, which some users report lessens with each dose, the side effects associated with injectables can be negligible. That’s a far cry from the old days, when HIV meds often came with lots of adverse side effects. 

That might be why convenience is often cited as a main reason for switching. For many, the prospect of no more pills is enticing.

For Andrew Northup, an Iowa native living in Washington, DC, there was another motivating factor at play: being a relatively early adopter was an opportunity to propel the science of HIV. Diagnosed with HIV in 2018, Northup switched to a long-acting injectable in 2023. 

“I was on a daily pill at the time, getting my health care through Whitman Walker [a venerable HIV clinic] in DC and they’re always on the forefront of HIV care and LGBTQ health care. My doctor said, there’s this injectable, it’s once every two months, would I be interested? I’m always down to try something new, so I said yes,” Northup says. 

Having taken part in a previous HIV study, Northup said he sees himself as part of a long tradition of LGBTQ people participating in trials and adopting novel medications to protect themselves and their community. He hopes his relatively early embrace of long-acting injectables will lead to longer-lasting formulations with fewer side effects.

“I feel like switching from a pill to an injectable kind of pales in comparison to what others went through in those early years of the AIDS crisis,” Northup says. “But if I can help drive things forward scientifically, if I can carry on that legacy, of course I will.”

In addition to helping advance science, long-acting injectables have also helped Northup keep HIV in check. “I recently had a checkup,” he said. “Everything looked good and has looked good for a long time.”

Northup owes much of his success managing HIV to good fortune, timing and privilege. He cites an accepting family and community, access to quality health care and an AIDS specialty clinic within walking distance. “That’s a very fortunate thing, and not everybody has what I have,” he says. 

That might explain his soft spot for anyone who’s not quite ready to go public about their HIV status. 

“I understand people that aren’t out about their status,” he says. “It’s scary to feel like you’re alone. I feel comfortable being outspoken and just feel comfortable being me because I feel very supported by my community. I know that I can be HIV positive, and I will still be accepted and loved. I was very much in a place of fear and shame at first. And as I processed that and got out of it, I realized how liberating it was to walk in honesty.”

Although Northup is optimistic that better, longer-lasting HIV injectables are on the horizon, he remains discouraged that quality health care remains out of reach for so many people in this country living with HIV. 

“That’s why so much of the struggle, so much of activism is intersectional,” Northup says. “Whether it be health insurance, affordable child care, education, good public transportation or equal access to the tools available to thrive. We need to fight for all these things and lift everybody up, because doing so has untold benefits for the individual and for public health.”