Table 2.

Patient Experiences with PrEP

Theme	Participant quotes
Patients self-reported high rates of medication adherence	It's only one pill so it's not that bad. I would just take one pill every night before I'd go to sleep, and that was it. I set a little reminder on my phone so I didn't forget it.
	At first I didn't feel comfortable taking a pill every single day. But right now I don't mind. It's not really a big deal.
Patients experienced few obstacles paying for PrEP and PrEP-related services	We have a card [government-issued flexible spending debit card] that we use to pay for co-pays.
	As far as I know, the insurance company pays for it. They haven't raised any flags or asked any questions.
	I went to Walgreens and [the pharmacist] said that [the drug manufacturer] has a co-pay program, which I had never heard of. Basically, I didn't have to pay my co-pay anymore. The co-pay was sent to the drug manufacturer. So that entire $70 was paid by them. She gave me the number. It took maybe fifteen, twenty minutes…. very, very simple.
Many patients engaged in high risk behavior before PrEP and continued behaviors after commencing PrEP (few reported increases in high risk behaviors)	I don't know that it's changed dramatically. A lot of my sex life depends on how busy me and my partner are. The first few months that I was on PrEP I thought I was going be having a lot sex. But really I think I had about four partners, which is not an unusual amount for me.
	I don't have as many partners. I've gone from 60 or more partners to around 30 or 35.
	I'm in an open relationship, me and my partner, we like to try different things … we like to play. I've been with the same person for a few years now and we just like doing it, so I do see myself on it [for life], especially with the risks that are out there.
Most patients did not use condoms before commencing PrEP	We have explored other options. Condoms are still not a realistic option for us. I mean, I can lie to myself and say I'm going to wear those, but it's not going to happen.
	My partner count went down, but with the exclusive partners that I do have … it does tend to be unprotected sex.
PrEP promoted increased frequency of HIV and STD screening	So now every 3 months, I'll know my status. I'm kind of locked in to come and get tested, which is a nice thing because before, someone would have to twist my arm and drag me in [to get tested].
	When I started coming here, I was getting tested (for HIV and STDs) every 6 months. Now I get tested every 3 months.
Patients expressed interest in intermittent PrEP	Ultimately, I'm looking for a relationship and I feel like PrEP is definitely a temporary thing until I'm in a relationship.
	My thought was that I would take PrEP until I hopefully find a relationship where I don't have risk of exposure.
	For the foreseeable future I plan on staying on it. If there are any other options in the future I'd like to explore those options … I'm always up for hearing what's the next thing. I would trade it for something better, if it were ever available.
Patients offered suggestions for enhancing community awareness about PrEP and PrEP uptake	I think social media would be a great tool…. why not take advantage of it.
	Every month there's a Bareback sex party that's internationally promoted across the world. One of them happens in Providence. It would be perfect to have a [PrEP awareness] station.
	Have PrEP go mainstream. Buses have advertisements all the time. You have every walk of life on that bus. Somebody's going to see it and think … maybe I should go get tested or I know somebody who should, why don't I refer them to what I seen on the bus at a bus stop, get the public aware and knowing about it no matter what.
Patients suggested community-based physicians needed more information about PrEP	I am surprised by the number of physicians who don't know what PrEP is. I think if the physician community doesn't know, you can't possibly expect the regular, non-medical people to know.
	When I go to a doctor's office, they said to me … is this drug for your heart?
	When [my primary care doctor] found out I was on Truvada he asked me “Why are you on Truvada? You're not positive.” I said, “It's a preventive medication.” … It was one of those things where he didn't even know.