Therapeutic equivalence, different stigma: Pills and long-acting injectable antiretroviral treatment imaginaries among gay and bisexual men living with HIV in Colombia

Long-acting injectable antiretroviral therapy (LAI-ART) is an emerging HIV treatment whose social implications extend beyond its biomedical effects. To explore how LAI-ART is imagined in contexts where it is not yet available, we conducted 66 semi-structured interviews with gay and bisexual men living with HIV in Colombia. Guided by the concept of the social plasticity of pharmaceuticals - the capacity of medicines to acquire shifting social meanings beyond their pharmacological action - we explored how participants anticipated LAI-ART might reshape HIV-related stigma. First, LAI-ART was imagined as affording freedom from daily pill-taking and the burden of constant HIV management, offering relief from a persistent reminder of living with HIV. Second, oral pill bottles were described as "stigma objects," while injectables were imagined as invisible treatments enabling concealment and reducing social exposure to stigma. Third, participants linked LAI-ART to greater secrecy within social relationships, and framed injectables as symbols of scientific progress that could help dissociate HIV from illness. Finally, some participants emphasized the limits of pharmaceutical solutions, arguing that stigma is rooted not only in treatment practices but in broader contexts of misinformation and moral judgment about HIV. Our findings suggest that while pharmacologically equivalent, oral pills and injectable ART can be socially distinct, with LAI-ART expected to serve as a partial buffer, though not a remedy, for HIV-related stigma. As LAI-ART is not yet available in Colombia, participants' accounts primarily reflect internalized and anticipated stigma; future research is needed to examine its effects on enacted stigma once implementation occurs.