You Can Suppress It, But It’s Still There”: Navigating Safe Uncertainty in HIV Cure Research – Narrative Perspectives from Women and Migrants With HIV

<title>Abstract</title> <p>Background People with HIV (PWH) who are women and/or migrants are underrepresented in cure trials, raising equity, acceptability, and research generalisability concerns. Cure research engagement requires PWH to navigate uncertainty about their bodies, futures, and intervention risks. Understanding uncertainty management is essential to ensure inclusive and ethical studies. Methods Alongside HIV community organisations, we interviewed PWH who are women and/or who speak a non-English language at home attending an Australian tertiary academic hospital infectious diseases clinic. Interviews explored HIV research knowledge and perceptions, participation motivations and barriers, and trial preferences. Interviews were audio-recorded, transcribed, and examined through Riessman's narrative inquiry framework. This is a narrative analysis of three selected interviews from a twenty participant cohort viewed through Mason’s theoretical framework of "safe uncertainty". Results These narratives illustrate participants navigating the uncertainties of HIV and cure research participation. Despite long-term viral suppression, all described persistent psychosocial impacts - mediated through daily medication, embodied vigilance, and residual concerns about infectivity. Treating clinician trust was a central mechanism through which participants moved toward safe uncertainty, enabling engagement with cure research despite unresolvable risk. Participation motivators included altruism and personal hope; coexisting with concerns about treatment interruption, viral control loss, and privacy. Conclusion HIV cure research requires acceptance of uncertainty for possible benefit. These narratives demonstrate that participation is shaped less by risk calculation than by the quality of clinical relationships and social context. Trials designed with this understanding - considering trust and lived experience alongside scientific rigour - are best positioned to achieve equitable and informed participation.</p>