Interview Procedure

One-on-one semi-structured in-depth interviews were conducted by CL via videoconference (Zoom or WeChat video call) in Mandarin Chinese and lasted 60–100 min. Before the interview started, all participants provided electronically signed informed consent that included an explanation of the study design, purposes, potential risks and benefits, confidentiality, and the voluntary nature of participation. Each participant was interviewed once and received 75 Chinese Yuan (~ 11 USD) as compensation upon completion of their interview. The interview guide (Supplementary file 1) was informed by the IMB model [21] with tailored questions for PrEP-naïve participants and current or former PrEP users. At the start of the interview, CL introduced themself to the participants as a cis-gender female Chinese researcher studying HIV-related LGBTQ health in China. Those previously unaware of PrEP were given a brief standard introduction (Supplementary file 1).

During the interview, participants were asked about their PEP use history, knowledge, attitudes, willingness to use PrEP and PrEP use history, and past pathways, barriers, and facilitators to HIV testing and PrEP services. PrEP-naïve participants were asked about their background knowledge and concerns about using PrEP and how these concerns might influence their decision about whether or not to initiate PrEP. Participants with PrEP experience were asked about perceived and encountered barriers to initiating and managing PrEP and their views on what information they might have wanted to know before starting PrEP. Considering the impact of the COVID-19 pandemic on people’s lives and views of health, the experience of the pandemic was also investigated, including people’s assessment of any changes in their access to HIV prevention services, HIV testing, and PrEP. CL took notes during interviews and created an interview summary following each interview to capture predetermined and emergent themes. Throughout data collection, authors (CL, KM, JT) regularly met to discuss these summaries and field notes to monitor thematic saturation for each content area. When limited new information emerged, additional interviews with new participants (i.e., previously unrecruited MSM) were conducted to conclude the sample.