TABLE 2.

Illustrative quotes from interview participants

Theme with codes and subcodes	Quote
Theme 1: Barriers to HIV care included long distances to the nearest HIV clinic and transportation issues as well as anticipating and/or experiencing HIV-related stigma.
Code: Barriers to HIV care Subcode: transportation/travel distance	“Probably the distance to get to the doctor and to …my caseworkers. Because living in [town name] in [county name] and my doctors and [caseworkers] not being anywhere close. … And so it got to be sometimes an issue.”
	“I had terrible transportation. Then, once they had the bus, the vans would always end up late. Sometime the driver would forget to pick me up. It was very hard at first. …A lot of times I had to walk………They started helping me get transportation. It got a little easier on me and stuff.”
	“Well, by me staying here in [county name], there’s no doctors here. I have to travel where the doctors are, but to me… as long as I got transportation, I’m fine. Maybe another person may not have transportation because I have clients that don’t have transportation, and I have to take them back and forth to their appointments.”
Code: Barriers to HIV care Subcodes: HIV related stigma, anticipating stigma	“I wasn’t ready for people to know. Because I didn’t want to be judged or stigmatized.”
Code: HIV testing barriers Subcode: HIV related stigma	“If somebody sees you go in to get an HIV test, then they’re going to assume that you have HIV and it’s going to be said that you have HIV even if your test comes back negative. …people are going to be saying, ‘Well I wonder what she was doing?’ Or ‘I wonder where he was at?’ Or ‘I wonder if he’s sleeping with the gays because he’s going in?’ especially with men, and especially in the African American community…Not that that’s my views but I’ve heard people say things like that.”
Codes: Barriers to HIV care; challenges in life Subcodes: HIV related stigma; experienced stigma	“Being so strong as an advocate I still have some, not necessarily shame, but fear of stigma, fear of certain people finding out. …I don’t want it to hurt my family.”
	“The little kids was laughing, telling me ‘you’re bad’. But they really didn’t understand what was going on. …my son, he’d be outside, sometimes he would hear little kids say, ‘She got AIDS. The lady downstairs says she’s got AIDS,’ …it went on for a long time till [the neighbor] finally moved and now it’s over.”
Codes: Barriers to HIV care; challenges in life; HIV testing barriers Subcode: Fear of testing; knowing diagnosis	“I guess the only challenge was the denial process. That was my biggest challenge. Because I was in denial that it was even happening.”
Theme 2: Facilitators of HIV care included having a helpful HIV care provider and RyanWhite case manager and a social support network that aided them in prioritizing their own health.
Code: Facilitators to HIV care Subcode: Helpful providers	“My HIV doctor he’s very straight to the point. I feel confident in asking him any kind of question, I get a straightforward answer.”
	“You’re looking at a person that probably shouldn’t be even on the Earth …but somehow or another, I met the right people and people were concerned about me, put me on the right drugs and I eat the right food and my doctors have been concerned about my health. My doctor meets me with open arms.”
Code: Facilitators to HIV care Subcode: Case managers	“Anytime I have a problem, I just call her and she’ll get it straightened out. I couldn’t ask for a better caseworker.”
	“I have a great case manager… I have a personal relationship with her … I’m not going to lie when I say this: I rely on her. When I have questions about things… She answers them. She doesn’t know the answer, she’ll find the answer.”
	“I have a caseworker………helps remind me of my doctor’s appointment, and they’re there at the appointment with me, so if there’s something I forget to ask or I need to know, they can probably help me relate it to the doctor a little better than I can explain it. So, that’s a big help.”
Code: Facilitators to HIV care Subcode: Helpful providers	“…Because the care was good there, and even when I would miss an appointment they made sure, ‘[Participant’s name], are you coming, or you didn’t come; are you okay? Do you need a counselor; have you had your vitamins?’“
Code: Facilitators to HIV care Subcode: Prioritizing health	“I think it’s just best that I focus on work, my family, and my health. Health being my number one… I go to the gym. I eat properly. I don’t drink anymore. I don’t do drugs. I haven’t done drugs in years. If I don’t focus on those things there and put myself unselfishly first, then I’m not going to be around to be able to focus on work or my family or even myself.”
Code: Facilitators to HIV care Subcode: Support system	“I was worried that my daughter wouldn’t [inaudible] me and my grandchildren, that I couldn’t touch and kiss, and hug them like I usually do, but they never changed and that made me feel that much more better and accepting… Because it does get overbearing and hard to try to deal with it on your own and hide it.”
	“You just got to do what the doctor tells you to do and pray and talk to your family. Have somebody to lean on. That keeps me from being stressed out………I’d never give up on life. But I have gotten depressed. But I’ve always talked to my church pastor. Talk to people. I find that talking to people and praying changes things. It helps. It really helped me.”
	“Oh, I have some really good friends… If we’re together and somebody says something or does something, they’ll almost want to fight. Then, my family is really, really supportive. My children, all five of my kids know, and they’ve always known from the moment I found out… Because I have that support system, it makes it a little easier for me. But not everyone has that.”
Theme 3: Regarding programs or services, participants had the most favorable reactions to Ryan White case management, peer navigators, and telemedicine for HIV treatment/care.
Code: Reactions to programs/services Subcodes: Positive reactions; Ryan White	“I mean, the Ryan White program, that’s the greatest thing I’ve ever heard!”
Code: Reactions to programs/services Subcodes: Positive reactions; negative reactions; Ryan White	“I have had just general disappointment with my case managers because I’ve had a couple different ones. Some have been good; some have been not so good.”
Codes: Reactions to programs/services; program recommendations Subcodes: Negative reactions; Ryan White; peer navigators; hiring PWH	“I think the Ryan White case management is a great idea. The way it’s been handled in the state I think is problematic. I don’t think that they are doing enough. I also think that they need to maybe invest in hiring people what are already HIV positive. Promoting individuals with HIV that care for individuals with HIV because they understand their needs and would be more compassionate and more willing to work with them…”
	“…if more people were concerned about HIV, it would be a better program.”
Code: Program recommendations Subcodes: peer navigators; hiring PWH	“Some people will appreciate the fact of having somebody that understands and knows what they’re going through.”
	“If you’re positive, then there should be somebody available immediately to talk to that person, and I think we need to use more positive people.”
	“Because I remember when I was newly diagnosed, even though I did seek care faster than some people, but not everybody is in the same place I’m in, or I was in at that time. Some people do take a little while, but if they know that there are programs, if they know that they can meet a person that can understand where they’ve been or where they are right now………I think that would be a benefit, to be able to meet a real person.”
Code: Telemedicine/TelePrEP	“I think it’ll be great. That would be something. Yeah, definitely.”
	“I think telemedicine and TelePrEP are great new innovations because they can reach the hard to reach clients and it cuts down time that people have to take off from work.”
	“As for HIV care, it is also very helpful to be able to do telemedicine, because most of us are working class people.”
Theme 4: Most participants demonstrated resilience overcoming various obstacles as they worked towards being healthy mentally and physically while living with HIV.
Code: Challenges in life Subcode: optimistic/positive outlook on life	“…I’m a pretty go-getter. I’m the type of person where if I’m faced with a challenge, I like to meet it head on… I’m focusing more on me and my health as opposed to in my past; I was too focused on just having a good time, going out drinking with my friends, and focusing on having a boyfriend. …I’m more focused on my health, providing my household, which is just me, with the things I need to stay healthy and live a good life.”
Code: Challenges in life Subcode: Health care challenges	“I think me being sick with my heart, it tripled my HIV. …But I was just throwing up a lot. I didn’t know if I was throwing up the medicine or what, but I know I missed a dose of it. . ………When I was in the hospital, the heart doctor told me to take, and I talked to the HIV doctor too, he told me to take my medicine every morning the same time. So I got on that. Ever since I did that everything been doing good.”
Code: Challenges in life	“Challenges are staying motivated right now. I’m still trying to get back in the flow of things through COVID and just being stuck at home by myself because one of the things I realized was I’ve never lived alone in my 46 years.”
Code: Challenges in life Subcode: optimistic/positive outlook on life	“I don’t live a really exciting life, but it’s fulfilling for me.”
	“Oh, it’s going great. My kids, they don’t know the situation [referring to the HIV diagnosis], but they’re in my life. I got a fiancé. I got a job. I have a place to live, it’s not much of a place, but it’s home. So life’s going pretty good.”