Table 3.

Illustrating quotes on reasons to decline PrEP initiation

Reason for PrEP decline	Example quotation
PrEP perceived as too similar to ART	“They told me that I will be taking the pill every day. And I thought that I do not like taking a pill and that it will be like I am taking the AIDS pill; that I would take the pill every day and every day. ” (Female, 20, control phase)
Perceived inability to adhere	“I think it’s going to take me a long time to consider taking it. The nurse told me that this a pill that is taken daily for it to be effective and since I have a busy kind of lifestyle, I don’t think I’ll manage. I am an alcoholic and I club a lot. This might lead me into forgetting to take the pill at the stipulated time I would have chosen for myself. ” (Male, 30, PPP phase)
Knowledge of PrEP not sufficient to make a decision on the day	“I can’t make a decision now on this day. I need more time to read and understand this information. ” (Female, 26, PPP phase)
Need to consult with partners before they can begin PrEP	“I thought that even myself I can love to take them for prevention, but I may want to start to talk to my partner; then return to take the pill. Otherwise it’s a good one. ” (Female, 21, control phase)
Fear of stigmatization and arguments	“Then I also mentioned PrEP at home to my partner, and he said ‘No, it’s not like that. The nurses are lying. This pill is for AIDS, not for prevention. There’s no such thing as a pill for AIDS prevention. This pill is for AIDS’. And then I considered the fact that if I decide to take it, then he’ll say I’m taking AIDS pills and I don’t tell him. We’d get into a heated fight because he might even just say it’s actually the AIDS pill and that I’m hiding the fact that I’m taking HIV pills. You see that? ” (Female, 31, control phase)
	“I told the father of my child that these are the pills they gave me at the clinic to protect myself from getting infected, and he asked me some questions that since I’m taking these pills, do I not trust myself? And I told him there are no secretive things that I do but I just want to keep my life healthy. We argued and it was bad; and he continued to say that there are things that make me not trust myself. And I told him I did not do anything secretive. So we continued arguing that I was being unfaithful to him.” (Female, age not disclosed, PPP phase).
Use of other prevention methods	“I think it’s because when I - most of the time - when maybe I’m having sex, we use a condom.” (Female, 20, PPP phase)

PrEP=Pre Exposure Prophylaxis; ART=antiretroviral therapy; PPP=PrEP Promotion Package