Table 2.

Provider-Identified Client Level Barriers and Facilitators to PrEP Initiation.

Barriers	Illustrative quotes
Concerns • Disclosure • Stigma • Side effects • Costs	* “Patients who live in the area, they would rather go to Mobile for care and some of the patients from Mobile who’d rather come to Mount Vernon for care for fear of someone knowing them….” * “I think one of our bigger problems is to get the stigma off of providers who are looking at this the way they looked at birth control when it came out. ‘Well, if I give it to ‘em they’re gonna have sex.’ Well, they’re gonna do it anyway.” * “What I’m hearing from [people living with HIV] is that their friends are afraid to take PrEP because of the side effects.” * “two of the three that I have on PrEP are young gentlemen over 26 that are no longer on their parents’ insurance. Lack of insurance and getting them to complete the necessary paperwork for patient assistance has been a barrier just to get them the medicine because they can’t afford it.”
Lack of knowledge •about PrEP • about risks	* “The other barrier I have is simply people don’t know. They don’t know…. We need to put fliers in barbershops, nail shops, hair shops. We need to put it where our people are. * “[T]hey just don’t think they need it. They don’t see it from the perspective I’m seein’. I’m like, 'If you’re worried that your partner is not being faithful to you, then you need to do something different. Either A, you need to wear a condom every time or B, you need to get on PrEP so that you have prevention for you.'” * “It would help patients with HIV, just maybe help them have those conversations with their partners…. I’m discussing it with my HIV positive patient. Their partner's not part of the visit, so I’m just wondering how much of the information that I’m giving them is bein’ transferred back, so I think a handout would maybe help them have those conversations as well.”
Lack of trust in provider	* “[I]t sounds like sometimes they don’t trust the person…—their PCP [primary care provider]. They don’t wanna have that conversation. They don’t wanna talk to their PCP about what they’re doing.”
Facilitators	Illustrative quotes
Trusted referral source (eg friends, peers, etc)	* “I have a lot of patients who have now started telling friends to come and get it, so I’ve seen an increase in uptake.”
More information about PrEP	* “Something educational that could be on the wall that could—that's colorful and draws people's attention that might spawn them to read it….”
Trusted treatment providers	* “Sometimes if you have a good RN who's okay with talkin’ about it [sexual activity], that's something that sometimes a provider can be like, 'Hey, can you just go in and smooth something over and see what's goin’ on?' … Sometimes they can do that and get more information….”