Table 4.

Selected list of barriers and facilitators identified in online posts: representative quotes

B/F	Theme	Exemplary quote
Access
F	Specialized roll out marginalized populations	“[There] are individuals who don’t access regular care, are discriminated against, tend to distrust the healthcare system, and don’t connect themselves to the AIDS epidemic either personally or publicly. They will need outreach to connect them to care. They will need education to help them see the need for care. They will need skills to help them with adherence” [59]
F	Trust in provider	“Had an appointment today with [a doctor] and they were amazing. So long as my lab work is fine I should be on PrEP in no time… They don’t judge and will answer any questions you have” [64]
B	PCP not educated enough about PrEP	“Many of my first attempts at receiving PrEP were shot down by doctors who just weren’t educated about it or honestly being judgmental about it and not prescribing it” [64]
Attitudes/beliefs
F	PrEP decreases anxiety/stress during sexual encounters	“I have been on PrEP for 11 months and the anxiety I have had about getting HIV through sex has been reduced by 100%” [62]
F	Condoms are also flawed	“If safe sex with condoms worked, we would not have the continued spread of HIV among gay men, so that argument is a FAILURE” [63]
B	PrEP perpetuates stigma of homosexuality and HIV	“Anyone who engages in risky sexual behavior should take extra precautions, be it through PrEP or otherwise. While I’m certain that the WHO acknowledges this, their message nevertheless helps perpetuate the falsehood of HIV being a gay disease” [55]
Attribute of PrEP
F	PrEP allows you to be sex positive	“’The virus is the problem,’ he said, adding: ‘People can and should have as much as sex as they want to have. We need to focus on how we can attack the virus as opposed to sex-shaming people or trying to police the quantity of sex that they have or the quality of sex that they have or who they have sex with” [61]
B	Long commitment	“And there’s no end-game, you just take it forever” [60]
Behaviors
F	Existing practice of condomless sex	“You cannot count of condom use all the time.’ It would be like asking the heterosexual community to wear them for thirty years to halt population growth. How many couples would be able to maintain it? But that’s what MSM are expected to do 100% of the time. Even with the risk of HIV disease it can’t be done-human nature” [56]
B	Difficulties with adherence	“Guys can’t even remember to wear condoms, but they’ll remember to take a pill they really don’t need every day. Yep, this should help to make things less complicated (sarcasm)” [63]
Sociodemographics
F	Being “out”	“It’s going to have to come from within the younger generation. And frankly, it starts with the Truvada whores. What a beautiful movement. Here are the guys who are coming out. Coming out has been the secret ammo for the LGBT movement from Day 1. Whether it was coming out as gay or lesbian, or HIV positive, or having AIDS, or now just announcing how you’re protecting yourself against HIV/AIDS” [51]
Social network
F	Facilitates the conversation about HIV	“PrEP has at least started a conversation about how gay men want to have sex and why” [62]

Complete list of representative quotes available in Supplemental Table 1