Table 2.

Barriers to PrEP initiation and Persistence

Broad factors	Current study themes	Themes reported in 2016 (Arnold et al., 2017)
Structural factors	Cost (being told PrEP was free and then having to pay a fee) Lack of discrete clinics Time commitment (for medical appointments and picking up medication) Competing interests / Not wanting to take a daily medication	Access to payment assistance programs Copayments and deductibles for medications and related services
Social factors	Not knowing anyone personally taking PrEP (Needing to “mentally prepare”) Unaware of HIV risk HIV stigma and homophobia (assumption of promiscuity, not wanting to be labeled gay, fear people think they are living with HIV) Fear partners will find out they take PrEP	HIV stigma and homophobia Relationship status changes
Behavioral factors	Sexual risk behaviors (only one sex partner) Denial (“it won’t happen to me”) Less priority for prevention vs. treatment	Changes in sexual risk behaviors
Clinical factors	Misunderstood side effects (Fear of dependency) Fear PrEP won’t work	Perceived and actual medication side effects