Recommendations for HIV care continuity during droughts and floods with key populations living with HIV in Kampala, Uganda: Qualitative insights

Background Climate change and extreme weather events increasingly threaten HIV care continuity, yet evidence centering the lived experiences of key populations living with HIV remains limited. To address this knowledge gap, this qualitative study elicited recommendations for strengthening HIV service delivery during droughts and floods with young men who have sex with men (MSM) and female sex workers (FSW) living with HIV in Kampala, Uganda. Methods This community-based qualitative study involved semi-structured interviews with a purposive sample of young people (aged 18-24) living with HIV (8 MSM, 8 FSW) and 20 key informants from community leadership, climate, and HIV sectors from May-July 2024. Data were analyzed using framework thematic analysis and organized across institutional, community, and household level strategies. Results The 36 participants included 16 people living with HIV (8 MSM, 8 FSW; median age 23.5) and 20 key informants (7 women, 13 men) representing community leadership ( n = 4), climate and environmental issues ( n = 8), and HIV expertise ( n = 8). Participants identified multi-level and interconnected strategies to sustain HIV care during droughts and floods. Institutional-level recommendations included decentralizing and mobilizing antiretroviral therapy (ART) delivery, expanding multi-month dispensing, maintaining emergency drug buffers, integrating nutritional support to address food insecurity, and equipping frontline workers for adverse weather conditions. Community-level strategies emphasized livelihood and savings initiatives, environmental management, infrastructure improvements, peer support networks, and targeted outreach during weather-related disruptions. Household-level strategies included strengthening food and water security, diversifying income sources, planning ahead for treatment continuity, and using practical transport solutions, such as bicycles, to overcome flood-related barriers. Conclusions Sustaining HIV care during weather-related disruptions requires coordinated responses that extend beyond the health sector. Climate-resilient HIV programmes should integrate service delivery adaptations with social protection, livelihood support, infrastructure investments, and community-led interventions to enable uninterrupted HIV care for young Ugandan key populations with HIV in climate-affected settings.