Menopause in the shadow of HIV: clinician and women perspectives on integrating menopausal care into HIV services in southwestern Uganda

Introduction Women living with HIV (WLWH) experience earlier and more severe menopausal symptoms, yet access to evidence-based menopausal care remains limited. In sub-Saharan Africa, where HIV is most prevalent, implementation gaps persist in integrating menopausal care into HIV services. We explored perspectives of WLWH and HIV clinicians in Uganda to identify multilevel barriers and facilitators to integrating menopausal care into routine HIV services. Methods We conducted a qualitative study between August and December 2025 at HIV clinics in Mbarara and Masaka Regional Referral Hospitals, Uganda. Using purposive sampling, we interviewed 29 participants, including 19 WLWH aged 45–60 years (6 premenopausal, 6 perimenopausal, and 7 postmenopausal) and 10 clinicians representing junior ( n = 2), mid-level ( n = 5), and senior ( n = 3) cadres. Semi-structured interviews were audio-recorded, transcribed verbatim, and analysed using a theory-informed thematic approach guided by the Theoretical Domains Framework (TDF). Data were coded deductively to TDF domains in Dedoose until no new themes emerged across successive interviews. Results Key barriers to integration included clinicians’ limited knowledge and skills in menopausal care, which contributed to symptom misattribution, as well as low menopausal health literacy and stigma among WLWH that impeded care-seeking. Additional barriers included professional role ambiguity driven by prioritisation of HIV performance targets, and structural constraints such as absent clinical guidelines and medication shortages. Facilitators included trusted client–provider relationships that supported holistic care, community peer- and faith-based networks that normalised menopausal experiences, and stakeholder consensus on the need for integrated menopausal care into routine HIV services for optimal long-term HIV care outcomes. Conclusion Our study found that menopause is invisible, misattributed, and structurally neglected within HIV services. Knowledge gaps, role ambiguity, resource scarcity, and symptom misattribution hinder integration of menopausal care into HIV services. Leveraging trusted client-provider relationships and peer networks to co-create clinical guidelines and context-appropriate implementation strategies could achieve holistic health for aging WLWH in sub-Saharan Africa.