Table 3.

Qualitative interview themes and exemplary quotes.

Theme	Sub-theme	Detail	Exemplary quote
Mental Health	Past experiences with mental health services	Negative childhood experience	“I think when I was younger, I went to, not like gay conversion, but just like, somewhere where it’s like, ‘Oh, you’re not actually gay, you don’t know what you want because you’re 10.’ And that, to me, left like a really negative view on therapy…” (26 year-old, male).
		Medical mistrust	I’m very skeptical. I don’t really like to - unless it’s a reason or something that’s beneficial, I really don’t like meeting a lot of new people and telling people my life.” (20 year-old, female).
	Relationships with mental health providers	Positive qualities of a therapist	“She listened to everything that I was going through…I was really in a deep depression. It was like a lot of stuff she did or a lot of stuff like services she gave me or told me about. It kind of worked for me.” (24 year-old, female).
			“I like a therapist that’s adaptable… If… you’re adaptable, no matter what the mood, no matter what the situation, no matter where we at, I’d like that, because that means I could talk to you like I could talk to you like I talk to my friends.” (29 year-old, female).
		Negative qualities of a therapist	“They said, ‘uh-huh, okay.’ That was all I got… Well I could have done this myself… I could have talked to a teddy bear. Thank you, no!” (23 year-old, male).
	Stability in accessing mental health services	Overbooked and unavailable providers	“So, the therapist there… just overbooked like Beyoncé or somebody. And our initial visit was - well, it was cool. Like I was talking about stuff, but then that was the only visit. It was like, oh, well, like I can see you once a month. And for me, I don’t think that that would work. Like, the once-a-week thing really worked for me, and it helped me stay consistent and committed.” (25 year-old, straight, female).
		Turnover of providers	“When I have regular therapy, [providers] keep quitting me… Well, my last therapist, I had her for five years. She left for more money. The [other] therapist, I had her for a year, she left for more money.” (29 year-old, female). She went on to report that “the agency doesn’t have another therapist and I have to wait pretty much on a waiting list”.
Substance use	Social, community, and mental health-related reasons for substance use	SU to feel less bothered by realities of lives, and wanting to forget about HIV serostatus	“I did meth and I drank a lot, but the meth would just take me into a different world. And, yeah, I didn’t have any care. I was like invincible Wonder Woman… [alcohol and meth] just helped numb things, put it in the back of my mind where I didn’t have to remember about it and talk about it with people…” (25 year-old, transgender female).
	Medication non-adherence due to substance use	ART non-adherence	“Sometimes when I get too high I might fall asleep and forget about the pills … I couldn’t take it the next morning because, you know, the hours. So I would have to wait until the next night.” (20 year-old, female).
Use of technology for health	Facilitators of videoconferencing	Convenience, less travel time, prevent inadvertent disclosure	“…if I could… [videoconferencing platform] with a therapist, that would make things so great for me, because… I don’t want to travel to wherever you are and have to wait in your waiting room…So, I think it’s convenient.” (25 year-old, transgender female)
	Barriers to videoconferencing	Rapport building	“Personally, yes. I do think it should be a face-to-face, a physical thing. I mean, granted that technology is great… technology is helping people, but we’re getting too tied into it. Like, okay, great, you want to [videoconferencing platform] them from time to time, go for it. But, don’t eliminate the person-to-person. It has to happen at some point in my opinion.” (25 year-old, genderqueer)
		Lack of private space	“It seems good but a lot of people don’t have space for them to talk about it because it’s a public place and if you’re at work it’s hard to find a private place to talk because there’s people running in and out. I mean, when I got that call [referring to the call when her provider told her she tested positive for HIV] I couldn’t talk to her really so she just had to tell me about it because I was in the kitchen.” (20 year-old, female)