ABSTRACT
Pre-exposure prophylaxis (PrEP) is the first biomedical regimen approved to significantly reduce HIV transmission risk. Men who have sex with men (MSM) living in the South represent one of the most HIV-vulnerable populations; however, PrEP initiation is slow in this demographic. The factors leading to clients' decisions to initiate PrEP are relatively unknown. This study interviewed 14 MSM PrEP clients from 3 Southern states. The analysis revealed that 5 factors were integral to the sample's initiation of PrEP: HIV risk acknowledgment, HIV concern, PrEP understanding, PrEP accessibility, and PrEP consideration. From the analysis, a model emerged conceptualizing the decision-making process of PrEP initiation in this sample. This model is foundational to understanding the factors and their relationships affecting initiation of PrEP and can be used to develop effective interventions to facilitate PrEP initiation in MSM in the United States.