HIV pre-exposure prophylaxis (PrEP), particularly long-acting injectable formulations (LAI PrEP), has the potential to reduce the number of new infections among people who inject drugs (PWID), especially in low resource settings in the context of low coverage of harm reduction services, high HIV incidence, and substance use and instability. Few studies have examined PrEP perceptions, preferences, and service delivery models among these populations. We aimed to characterize acceptability, perceptions, preferences, and barriers/facilitators of different PrEP options, including LAI PrEP, among a cohort of PWID in New Delhi, India. This mixed methods study (March 2024-March 2025) included focus group discussions (FGDs) followed by cross-sectional survey data covering PrEP awareness, acceptability, and preferences and a discrete choice experiment (DCE) on LAI PrEP. FGDs indicated there was little prior awareness of and interest in PrEP, with concerns about what PrEP medications may do to their body or how it would make them feel. Hesitation surrounding PrEP was also driven by low personal HIV risk perception. Among 389 surveyed, 96% had no prior knowledge of PrEP; 72% indicated they would rather not take PrEP, with 20% preferring LAI PrEP, 5% weekly pills, 3% undecided, and no one preferred daily pills. Preferred characteristics of LAI PrEP were less frequent injections, delivery at existing healthcare clinics, and payment or incentives. PrEP programs of any modality aiming to build demand and deliver PrEP to PWID should consider how these populations often differ substantively in knowledge, needs, and preferences from other populations that have so far been the focus of PrEP campaigns.