In March 2025 a primary care physician told a patient who was restarting a daily HIV-prevention pill that a six-month injection was "coming out fairly soon." In April, the same physician told another patient that nothing had been approved yet. On June 26, eight days after the approval, a third patient heard: "It was approved last week."
By November that physician was describing what the first patients looked like when they came back for their second dose.
We know this because those visits were recorded. ZoomRx members record real, consented, de-identified conversations with their own patients, and over 2025 nineteen primary care physicians recorded 43 of them on one subject: how to prevent HIV. Nine of those visits happened before the first twice-yearly injection was approved on June 18. Three happened in the ten days after. Thirty-one happened in the months that followed. Five of the physicians are on record on both sides of that date.
That is something a survey cannot give you: the same people, talking about the same decision, before it existed and after they had to make it. Here is what changed in the room, and what did not.
In the winter and spring visits there were three choices: two daily pills and an injection every two months. Physicians already differed on how hard to push the injection. One called herself "a big fan of it." Another described it as "a bit of a nuisance" because it has to be given in the office.
What they agreed on was why patients ask for a shot at all. Forgetting. Too many other pills already. Not wanting the bottle in the house. One physician's line about patients who choose the injection stuck with us: "at least they admit it."
Two physicians were already telling patients that something longer was on the way, months before they could prescribe it. "Nothing's been approved yet," one said in April, "but I know that work is being done."
Three visits were recorded between June 23 and 28. They show how uneven the first week of a new drug is.
One physician had no sales rep yet, had not settled on the brand name, and said so: "I don't have any information on that one yet, but as soon as I get more info, I can go over it with you." Another, who has treated HIV for decades, walked a patient through the whole regimen and called it "quite remarkable." A third knew the name but not yet whether any pharmacy had it or whether insurance would pay.
By the autumn, the explanation had settled into a pattern: a new class of drug, a smaller needle under the skin rather than into the muscle, and two visits a year instead of six. "Frees up your schedule a little bit," as one physician put it.
The obstacles that remained were practical, not clinical. The title of our paper came from one physician's summary, after a patient used the word "bump" for an insurance delay: "The bump meaning the injection, or the bump meaning the delay in your insurance? Okay. Two bumps there."
The first bump is physical. The injection can leave a lump under the skin, and physicians described its size with whatever was to hand, a quarter, something smaller than a golf ball. Several asked the patient directly whether that would put them off. Two read the reference information aloud, in the room, as they went.
The second bump is coverage, the most discussed subject in every autumn visit. Here the physicians split on tactics. Some aimed for the new drug first ("let's shoot for the stars"). Others started with the older injection because it was easier to get approved. Most had a plan B and a plan C ready before the patient left.
The most useful thing in these visits is a genuine difference in practice. Some physicians were prescribing the six-month injection within weeks of approval and said why: a class they trusted, patients who wanted it. Others, as late as December, told patients the option existed and that they were not offering it yet, for two different reasons. One wanted more experience of their own: "I just like to do my research first on my patients before we jump into that." Another was waiting on insurers: "once those insurance companies start covering it, I will be more comfortable prescribing it."
Neither is wrong. Both are what your peers actually said, and we kept both.
Many patients heard about both injections and kept their pill. No physician argued. "There's nothing wrong with what you're currently doing," one said. "It's really just more about what makes sense for you."
And whatever the interval, the visit still turned on the same things: a negative test before every dose ("no blood, no shot"), staying in care, and being treated as a person.
The full paper, with 98 verbatims across eleven themes, goes to members of the ZoomRx community in primary care. It is one of nearly a hundred Peer Voice papers we have built this year, each one from real recorded visits in a single specialty, read in full and quoted across the whole set, with trial figures, doses and prices cut and every disagreement kept.
If you would like to see how your peers handle the conversations you have every day, or to add your own, join us. ZoomRx is a research community of physicians, nurse practitioners, PAs and other healthcare professionals. Membership is free, you are paid for your time by the minute, and you choose which studies to take.