Table 5.

Individual Barriers Quotations.

Barrier	LTC or EIC	Quote
Inaccurate Beliefs about ART	LTC	“Medications don't work. It didn’t have any impact on my immune status, improve my health or CD4 count, or decrease my viral load. So I stopped taking it.” (Female, 33) “HIV medications are addictive, so I don’t take them. As far as I know, we cannot kill any virus, so does it actually help?” (Male, 35) “Doctors abuse their power to prescribe medications for which they are being compensated, but not the most helpful ones.” (Female, 24) “I’m upset about using ART; My CD4 increase was miniscule. I felt even worse. I didn’t get colds or infections so regularly. Perhaps it was just psychological. It doesn’t work.” (Female, 33)
Practical Problems with ART	LTC	“They only dispense one month of medications. It’s difficult to get them this regularly due to time constraints.” (Male, 31) “The incompatibility with medications for other illnesses is a big problem.” (Female, 31) “I have to explain to the police what these medications are for.” (Female, 38) “Guests open my drawers, and the pills are labeled ‘Medicine for HIV’.” (Male, 39) “I work, and this prevents me from taking medications in a timely manner. I don’t want to cause unpleasant conversations. I work long hours, and they don’t give you enough medications when you get them. If I go on long trips, it doesn’t work. I’m not able to take them no matter what.” (Male, 28)
	EIC	“For about a month, ART was not available, and I developed resistance. I had to switch to another regimen.” (Male, 40) “People at work watched me take my medications. They asked me what is wrong with me. I had to make things up, like I am taking medications for allergies. I had to resign because I was so discriminated against.” (Male, 35)
Side-Effects	LTC	“I quit because of very severe side-effects. I was diagnosed in prison. They were choosing medications based on availability. I haven’t been able to take ART with the harsh side-effects.” (Female, 31) “Side effects always get in the way. The ones that bothered me most were rashes and jaundice. Hepatitis C and HIV treatment are very hard together.” (Female, 31)
	EIC	“I developed lypodystrophy but wanted to take ART. I was admitted, and they changed my regimen.” (Male, 40) “Of course there are side-effects, but this resolved. I developed anemia, and my doctor modified my regimen.” (Female, 26)
Substance Use	LTC	“Drunk people aren’t good at taking medications.” (Male, 60) “We have nothing to take these medications with except vodka… If I abuse alcohol for long, I get confused and disoriented.” (Male, 39) “When I was drinking, I had to choose between drinking and ART.” (Female, 38) “Heroin interferes big time.” (Male, 31) “Whenever I use drugs, I’m not motivated to take ART.” (Male, 30) “I stopped ART when I started using drugs. One doctor said that if I was drinking, I shouldn’t take ART. Whenever I’m on drugs, I don’t need anyone to talk to me…. I was on drugs without ART, and I had many chances to die without suicide.” (Male, 32)
	EIC	“Often, drug use is a barrier… I derive this from my experience, but when I started ART, I was no longer a drug user. But friends usually remember to take their medications when they get their next fix. Alcohol gets in the way. A couple of drinks – you’re fine, but abusing alcohol, getting drunk, you will forget.” (Male, 33) “I had a friend abusing drugs who refused to take ART because it interfered with drugs.” (Male, 40) “It’s very difficult for the average person to get an HIV medical appointment, but if you take drugs, it’s almost impossible.” (Female, 29)
Depression	LTC	“I quit taking ART because… I was very depressed.”(Female, 33) “Often, [ART] isn’t a priority –Often, I don’t want to live. When my CD4 cells are very low, it’s hard. I’m getting discouraged.”(Female, 33)
	EIC	“Being diagnosed was like a head injury. I wanted to commit suicide. I felt like I had a label on my head that said HIV. Later, I decided against suicide.” (Female, 35) “ART makes mental health worse. There’s depression, and there’s a temptation to leave everything and forget about it.” (Female, 36)