Table 3.

Participant Quotes for the CFIR Construct “Characteristics of Individuals” by Sub-Construct and Topic

Sub-construct	Topic	Quotation
Knowledge/beliefs about the intervention
Awareness	General	You gotta know about [PrEP]. It’s on BET channel all day. [Laughter].— Participant in FGD #3 (ages 25 to 30 years)
		[BSGLM] have all heard about [PrEP] but aren’t actually using it.—Participant in FGD #4 (ages 31 to 39 years)
Awareness plus other factors	Knowledge	[B]eing here in North Carolina, yeah, I’ve heard it more recently…But I haven’t really been educated on it.—Participant in FGD #1 (ages 25 to 30 years)
	Initiating care	[Y]ou got a TV, you know about [PrEP]. But do you actually take the steps of going to your doctor?—Participant in FGD #4 (ages 31 to 39 years)
	Access and finance	I do feel, because this is a topic of discussion I’ve had with my friends on several occasions, that the knowledge is there. But, the actual access and financial resources to [using PrEP] is not available.—Participant in FGD #2 (ages 31 to 39 years)
		Well, I think what information isn’t getting out there is that [PrEP is] available to you through different programs where you don’t have to pay for it.—Participant in FGD #2 (ages 31 to 39 years)
Initiation	How to	I feel like a lot of Black men in our community, and specifically here in Charlotte, don’t even have someone who they see regularly when it comes to medical care. And, if they don’t have access to that, they don’t know how to gain access. Some of them don’t even know where to start.—Participant in FGD #2 (ages 31 to 39 years)
	Hesitancy	Because first, you don’t wanna tell your doctor you’re gay. That’s the first thing, you don’t wanna say that. Because you’re be so embarrassed. Well, that Black pride thing.—Participant in FGD #4 (ages 31 to 39 years)
		There’s an insecurity going to the doctor, talking about HIV/AIDS and PrEP. It’s an uncomfortable conversation.—Participant in FGD #1 (ages 25 to 30 years)
		When I go to my doctor to get tested, I don’t see too many people in there. Not people that look like me in there, I’ll put it like that.—Participant in FGD #4 (ages 31 to 39 years)
Sexual health	General	[PrEP provides] confidence in sex life, maybe…it’s like an added insurance policy to your life. You’re adding value to what you’re doing every day.—Participant in FGD #4 (ages 31 to 39 years)
	Liberation	It’s sexually liberating [for BSGLM to take PrEP]…I would feel like I can have a partner that is positive and not be afraid, or not feel that I have to take other precautions about the type of sex with that person. So, I would be more inclined to date somebody that’s positive. —Participant in FGD #1 (ages 25 to 30 years)
	Not a priority	I feel like Black men feel like they are invincible…It’s a pattern that [BSGLM] just go out and start wilding out and just think that no harm can come to me. So, we cover [i.e., use a condom], but not that much. —Participant in FGD #2 (ages 31 to 39 years)
		That’s the question. It’s not gonna be, “[Do you have a] STD, STI?” You don’t have the discussion. [Instead, you have] straight-language, “Are you top? Bottom? Where you located? I’m on my way.” —Participant in FGD #4 (ages 31 to 39 years)
Relationship	Positive	[Using PrEP] shows a lot of initiative. It shows that you actually care.—Participant in FGD #4 (ages 31 to 39 years)
	Negative	[I]it could be a negative thing if both parties were tested and neither of them are negative and one of them wants to be on PrEP, it could be a trust issue. —Participant in FGD #2 (ages 31 to 39 years)
PrEP side effects	General comments	I’ve heard a lot of guys say, [because of] all the side effects, they don’t take it.—Participant in FGD #2 (ages 31 to 39 years)
	Truvada lawsuit advertisements	I think [the Truvada lawsuit commercial] is a concern for a lot of people…the underlining tone is there is a lot of concern there, or a lot of unanswered questions. Especially being that there hasn’t been any type of rebuttal against that from the pharmaceutical companies. I think there is still underlining [worry] and scare there because there is no rebuttal… —Participant in FGD #1 (ages 25 to 30 years)
	Pharmaceutical advertisements	I think [pharmaceutical TV advertisements for PrEP] are wonderful to have. But, I think what scares people…[is that people are] “Damned if you do, damned if you don’t.” Because if I get PrEP, it’s supposed to help me prevent HIV. But, at the same time, [it’s] giving me heart conditions, loss of bone density. It’s saying that it can cause liver and kidney problems. What the hell am I gonna do with that? .—Participant in FGD #4 (ages 31 to 39 years)
Testing	General	Nobody likes to get tested. It’s anxiety…Your blood pressure goes up, some people get high, some people pass out, some people get attitudes, some people ready to fight. —Participant in FGD #1 (ages 25 to 30 years)
Individual identification with the organization
Mecklenburg County PrEP Initiative	Awareness among Black same gender–loving men	People don’t know [of the MCPI program]…And, when people think that with maybe not having insurance or enough insurance, [they think] that these medications are expensive. —Participant in FGD #4 (ages 31 to 39 years)
		I think what information isn’t getting out there is that [PrEP is] available to you through different programs where you don’t have to pay for it.—Participant in FGD #2 (ages 31 to 39 years)
Individual stage of change
Pre-contemplation		Because most people…are actually scared to go in and get tested for [HIV]. So, even going to get the preparation about PrEP, we still have to get tested for HIV, so those are the things that scare them.—Participant in FGD #3 (ages 25 to 30 years)
		[M]ost same gender–loving Black men just don’t feel comfortable enough to talk about [PrEP], or some of them. It’s different avenues here. Some of them don’t feel comfortable. Some of them are not openly honest with their provider. The provider may not even know they are same gender–loving Black gay men. And then some of them probably just don’t care enough. I know that sounds terrible. —Participant in FGD #2 (ages 31 to 39 years)
Contemplation		I feel like most of the Black gay men are here: They got the information. They’re interested, but they still need another push, and then they’ll get there.—Participant in FGD #2 (ages 31 to 39 years)
		It’s just [BSGLM] aren’t motivated by the right people…They’re not saying they’re opposed to it. They’re just not around the right people who actually are making sure they get treatment or making sure they are getting seen regularly…. you just need an extra person there to advocate for you. —Participant in FGD #2 (ages 31 to 39 years)
Preparation		I do think that PrEP is a big topic. I think the follow-through is what we need help with. [BSGLM men think] “I’ve heard about it. I’ve talked about it. I’ve had a couple conversations about it. Hell, I’ve even visited a table and seen something about it.” But the follow-through of actually going to talk to a healthcare provider is the issue or the problem.—Participant in FGD # 1 (ages 25 to 30 years)
Other attributes
Provider trust	General	Excerpt from FGD #4 (ages 31 to 39 years): (Participant #1): I can only speak for myself on that one. I trust mine. I whole-heartedly trust mine. (Participant #2): I think that’s the reason people don’t go to the doctors, though, because people don’t trust them. (Participant #3): Maybe they feel like they won’t understand them as a Black person.
	Sexuality	I think that’s why maybe in the gay community, we are scared to go and tell you, the straight doctor, the straight Black doctor looking at me, “Hey, this is what’s going on with me.” You can still see there’s still that fear of just letting your guard down and telling people…but we have a fear as a Black man to go in there and tell another Black man this is what it is. You go in there, and he’s got a picture of his wife and kids in there? You really don’t wanna say shit. Now he’s looking at you, like “Ain’t this a bitch”. So, we’re scared of who you’re facing across that desk when you go in there.—Participant in FGD #4 (ages 31 to 39 years)
	Confidentiality	[It’s] not so much [that Black men do not trust medical providers]. I don’t think they trust anybody…that’s why I said in the beginning about the letting people know it’s very private about what we’re talking about when it comes down to each other’s status…Confidential, I guess you could say…. —Participant in FGD #3 (ages 25 to 30 years)
	Rapport	Because you have to build up that rapport. You have to be able to trust that person with a lot of confidential information, being able to share your lifestyle and share things that go on in it. —Participant in FGD #1 (ages 25 to 30 years)
Severity of HIV		Excerpt from FGD #2 (ages 31 to 39 years): (Participant #1): I feel like in today’s society, [BSGLM] are not afraid of it happening to them. We’re not seeing our peers and our people dying from it at a rapid rate. It’s more, “Oh, if I get it, well, then I’ll just take the medicine, and I’ll live another 30-40 years with no problem.” The scare is not there. So, I don’t think that they’re feeling that they can’t get it. They’re just not afraid of getting it. And, then a lot of people are trying to do away with the stigma if you do get it…So, it’s almost like if I get it, I’m not afraid. I’m not worried about what people are gonna think about me anymore. They’re just not afraid. (Participant #2): I do feel like on the opposite side of them feeling invincible. I do feel like there’s a big fear. So, you are fearful of finding out results. Because a lot of people after they’ve had unprotected sex, they don’t… get tested. They don’t. So, I think sometimes the fear is so great, it’s just like, “Well, I’ll just rather not know as opposed to know.”

Abbreviations. CFIR: Consolidated Framework for Implementation Research; FGD: Focus group discussion.