Table 3.

Themes and Subthemes From Focus Groups

Themes	Subthemes	Supporting quotes
Barriers to Pap testing among WLWH	Stigma	“…cause when you say AIDS to the youth; they automatically call you a junkie, you’re going to die, you know all that stuff.” (WLWH) “…they need to be able to talk about women who are still sexually involved, even though they are diagnosed. Because I had a doctor who didn’t tell me to stop having sex, he didn’t tell me I couldn’t get married, he says, as a matter fact, you can still get married, still have babies and all of that. And so because he encouraged me, I think we need to embrace that conversation. That women with HIV are still having sex, still marrying, still having children I think we are afraid to talk about that.” (WLWH) “I’ve encountered people who, once they find out that you are HIV positive, that treat you different. You know it’s like they are afraid to do the swabbing… because I mentioned that I’m HIV positive, or HIV diagnosed, they begin to push this urgency for me to go to a different clinic because they are not comfortable with treating me.” (WLWH)
	Limited health literacy	“The second thing I think that really keeps people in their groove if we are actually talking to them in their language. People begin to stray away when you begin to use terminology that they are not aware of.” (Outreach Worker)
	Competing priorities	“As a woman because you know holding down your household. I’m a full-time student, working full time. And my husband just lost his sight due to his diabetes. I have been literally focused on everybody else.” (WLWH) “How can I take off of work and care of myself because if I lose a day, I don’t get paid.” (HIV Clinician)
	Lack of awareness or knowledge about Pap testing	“Everybody’s walking around like they’re super women. Like nothing’s wrong with me, nothing’s going to happen to me. I don’t have to do this.” (WLWH)
Facilitators of Pap testing among WLWH	Wrap-around support from clinics	“[Our clinic] provides those wrap around services that no other medical facility do, because we really do understand there is a need for those supportive services in order to get to that final point.” (HIV Clinician) “You are going to 1,000 different appointments if you are HIV positive. So let's be proactive. Let's see if we can get everything done on one visit.” (HIV Counselor)
	Good patient-provider relationships	“They smile at us and, ‘Hey I’m glad to see you,’ and it’s not all fake and phony, it’s not about the dollars, they don’t hurry up and rush us out of there because they got a thousand clients… they take their time and talk to people. They don’t hurry up and get you undressed and get your legs up on a table. They actually care about how we feel. You know what I mean? They are actually listening to us, they are paying attention. And it ain't about their quota, their time schedule, it ain't about any of that.” (WLWH)
	Direct encouragement from peers and community members	I think if we can do something like that, have some real life people come in and talk about, you know, someone who might have been diagnosed with cervical cancer, I know for me I would listen to somebody that’s been diagnosed. She could tell me how to prevent being diagnosed, I would listen to that." (WLWH) Word of mouth is what got me in these programs. It’s powerful, especially one-on-one, because a lot of people don’t want to disclose especially if they’re not in an extremely private place they don’t want to talk (Community Advocate)
Future planning	Open group education	“In person is to me, is better than online…in a small intimate, people begin to get intimate with each other in regard to what's really happening.” (Outreach Worker) “Support groups are very good but for me having experience sitting in support groups as well as facilitating them. A lot of people don’t want that textbook of type stuff. Because I don’t want someone sitting in front of me with a book going through and reading it to me. I don’t.” (WLWH)
	Health care provider recommendation of Pap testing	"Doctors need to push more often, explaining to female patients why you need it." (Community Advocate) “I think my gynecologist, she should be aware and say, ‘Ok, even if though this is a female coming to me and this is what I normally deal with. This is a female with HIV so I need to make sure she’s aware and not just assume that I (the patient) am.’ I think she may assume that I’m aware of it.” (WLWH)
	Prevention targeted to younger generation	“Teach them. Cause if we don’t teach them, the street has a way of teaching them, which is all wrong behavior.” (WLWH) “As long as you have an open and honest discussion with your children then, maybe their friends or whatever, they may not have the same parent at home or some guardian that can teach them how to go about screenings.” (WLWH) “You have a situation where you have three generations. A young child, a young mother, and grandmother still under 40. At some point we to stop with that 40 year old and, say, get her to understand that some of the things that she did not do she needs to own them and go to that daughter and teach people the things they need to know and have those conversations making those possible changes easier to occur." (Community Advocate)

Note. WLWH = woman/women living with HIV infection.