Table 2:

Participant Quotes

OC Participant Quotes	IC Participant Quotes
Differences Between Groups in Attributions of Responsibility for HIV Care¹
I. “It’s- It’s, you know, it’s me helping them and they’re helping me but I’m not gonna put all the burden of them helping me on me. I gotta help myself too. So whatever they’re doing… it seem to be workin’. I help myself and theyhelp me when I can’t help myself but I’m not gonna put my whole… me trying to get better on them.” - Male, IC	X. “… being responsible adults, responsible for your means, we should be able to be responsible for ourselves. … And I should be able to, no matter what the situation, make my appointments. … I should be able to do that, but I haven’t, but I haven’t. So, not tryin’ to, not to make up an excuse or to sidestep my responsibilities, but…, because I have a problem, help me. Help me with my problem. Help me, because I have a problem missing my, you know, keeping my appointments.” - Male, OC

Intolerable Wait Times²	Patience with Wait Times³

II. “…It’s almost like, sometimes, people have the attitude that where, “Well you’re HIV positive, and we’re… we’re taking care of you, y-, you know, you, you… you, you gotta bow to our every word.” No, I don’t! No I don’t. I don’t have to! I don’t have to because, really, I, you know, I could just go to my civilian doctor and say, “To hell with you!” Get the same treatment. Civilian doctor’s gonna send me to a specialist. If he, my, if my civilian doctor doesn’t specialize in… you know, he’s gonna send me to… he’s gonna forward me to someone who does.” - Male, OC	XI. “I mean they seem to have worked at trying to cut down on the wait time. You know, I’ve seen, like in the lab and places where they seem to have cut the wait time down for a while, but, you know, it seems to slowly work its way back, but. And I know that’s just the amount of people that they see. And I’m sure some of it’s budget cuts, you know, because of the economy that we’re going through, that they don’t have as many people working as they probably would like to have working.” - Male, IC
III. “…I came in, I had an 11 o clock appointment, and I got- y’know runnin’ around the parking lot tryin’ to find a parking- I got in here about 12 o clock. “Oh, I’m sorry Mr. C, we’re not gonna be able to see you today. OK, we’re gonna have to…” But yet 99% of the time I come in for a 10 o clock appointment, they don’t see my dumb ass ‘til one. I mean, why is it OK for them to sit there and be two hours late but yet I get here fifteen minutes or an hour or whatever after my appointment is due and all of a sudden I get ostracized?” - Male, OC

Superficial Patient-Provider Relationship⁴	Trusting Patient-Provider Relationship⁵

IV. “…I, I like to have somebody that is kind of familiar with what is going on. And that I don’t have to keep going over the same history every time … The same questions that you’ve answered a hundred times and everybody has different ideas about how to approach whatever is going on…Because, by that time, all they want to do then is, you know, treat you for HIV. You may have some other things going on. Like, I had some things going with my feet and my hip and stuff, and my back. I never get seen about those things because by the time we go through all this other stuff, our only thing on your mind is get her the anti-viruses and let her go.” - Female, OC	XII. “I’ve got a fantastic doctor here. I absolutely love her to death. If she ever leaves, I’m gonna probably chain myself to the uh, desk out there and demand that they bring her back, ‘cause I love her. Um, she spends all the time in the world with me. If I need her for an hour, she’d spend an hour with me. And I’m sure the VA probably is not real happy with that, ya know, because of how bad, backed up she might get, but to me that’s the great part about it is I know that when I see her she’s gonna spend as much time as she needs to spend with me. She remembers everything about me. She knows what’s goin’ on in my life. She wants to know about everything that’s been going on in my life. Uh, I’ve just never had a doctor that cared that much, and that enough to remember everything and to ask me about it and see how things are, so. Uh, you know, if I could go to a place probably right next door to my house, if I couldn’t see her, I probably wouldn’t go.” - Male, IC
V. “…It wasn’t like I wasn’t telling ‘em. It wasn’t like I wasn’t saying, “there’s something going on here” and, ya know, “I think it needs to be looked at.” They would say, “oh it’s just something you have to deal with” and “just take this medication,” and, ya know, it just, it just wasn’t. They really, really need to realize that when you’re taking care of somebody with a life, you know, a life changing disease like that, that there’s other problems.” - Male, OC
VI. “…I have been with some; they don’t even look up at you. They’re…they’re in that thing, putting it in there. They ask you a few questions. They never look at you. They never identify with you. You know, um, I-I don’t like a doctor like that. I…I want one to at least treat me like I’m human.” - Male, OC
VII. “...I don’t trust the [pause]… the care here. The, uh, the undetailed care. I don’t think that they’re specialists. I think that it’s just a bunch of frickin’ students from [organization] that come over here and they’re making major life-changing choices on people’s lives. And I’m not gonna put my life in that care of a… of a 20 year old that is… has no frickin’ idea what HIV is doing to our nation, or to our world.” - Male, OC

Unsupportive Customer Service⁶	Nurturing Customer Service⁷

VIII. “…the other thing too is- and-and this is the main reason too, why I quit comin’ here, is I’m tired comin’ down here and sittin there sayin I’m on a three month schedule. Give me an appointment three months out. “Well we can’t give you an appointment three months out, uhh, our-our computers won’t go out that far…” What do you mean your computers don’t go out that far? Computers go out indefinitely. I mean I don’t see the same doctor, so who gives a shit. Pick a date.” - Male, OC	XIII. “Um, the staff here has been my biggest support staff. When I was I graduated from the University of South Carolina, Columbia, and that it was new to everyone so I can’t really blame anyone, but the [other] VA staff was not as friendly and open and receiving as this one was” - Male, IC
IX. “…And, and basically, it, it was, uh, that we’ll give you this next one, and, uh, you know, uh, uh, we hope that, you know, you get an appointment. Well, you just made me fall through the cracks. You just made me discouraged, to tell me to call back. And I’m trying to manage my healthcare. But you guys are so busy that, you know… I mean, do I have to walk in and, and sit here all day just to get an appointment, just to get my meds?” - Male, OC

These are examples from the qualitative data related to how IC and OC participants expressed their sense of responsibility for HIV care. The first quote is an excerpt from an IC participant describing the importance of personal responsibility in managing their HIV care. The second quote is an excerpt from an OC participant who initially acknowledges the importance of personal responsibility, but then undermines the acknowledgement by describing an inability to maintain that level of responsibility. This is not intended to be an exhaustive list of the excerpts from the qualitative data. Instead, these quotes were selected because they best captured the overall themes expressed by participants in each group.

These are examples from the qualitative data related to how OC participants describe the influence of clinic wait times on their retention in HIV care. The first quote is an excerpt from an OC participant criticizing the perceived inequity of patients being required to wait beyond the appointment time, but being punished under a strictly enforced rescheduling policy in the event of patient tardiness. The second quote is an excerpt afrom an OC participant describing the perceived indifference as evidence that the IDC took advantage of patients who have limited alternatives for HIV providers. The figure is not intended to be an exhaustive list of the excerpts from the qualitative data. Instead, these quotes were selected because they a

This is an example from the qualitative data related to how IC participants describe the influence of clinic wait times on their retention in HIV care. The first quote is an excerpt from an IC participant describing the perception that the IDC is proactively addressing the issue of long clinic wait times and the perception that long wait times are attributable to issues beyond the control of the IDC. This is not intended to be an exhaustive list of the excerpts from the qualitative data. Instead, this quote was selected because they best captured the overall themes expressed by participants in each group.

⁴

These are examples from the qualitative data related to how OC participants described the influence of the patient-provider relationship on their retention in HIV care. The first quote is an excerpt from an OC participant describing how the brevity of interactions with clinicians, combined with being asked the same basic health questions at each appointment, leaves little time to address other health concerns. The second and third quotes are from OC participants who are describing the perception that clinicians show little concern for participants during their interactions. The fourth quote is from an OC participant describing how interactions with individuals involved in research projects reinforce the perception that participants are not receiving the attention that they feel they deserve from clinicians. The figure is not intended to be an exhaustive list of the excerpts from the qualitative data. Instead, these quotes were selected because they best captured the overall themes expressed by participants in each group.

⁵

This is an example from the qualitative data related to how IC participants describe the influence of the patient-provider relationship on their retention in HIV care. The second quote is an excerpt from an IC participant who received care from a consistent clinician and perceived a close relationship that motivated them to remain in care and fostered a sense of loyalty to that clinician. This is not intended to be an exhaustive list of the excerpts from the qualitative data. Instead, this quote was selected because they best captured the overall themes expressed by participants in each group.

⁶

These are examples from the qualitative data related to how OC participants describe the influence of interactions with non-clinician staff at the AVAMC on their retention in HIV care. The first quote is an excerpt from an OC participant describing an example of how perceived issues with the scheduling contribute to difficulties involved in managing HIV care. The second quote is an excerpt from an OC participant describing how a perceived lack of commitment to patients’ health can contribute to OC participants’ feelings of frustration with the IDC. The figure is not intended to be an exhaustive list of the excerpts from the qualitative data. Instead, these quotes were selected because they best captured the overall themes expressed by participants in each group.

⁷

This is an example from the qualitative data related to how IC participants describe the influence of interactions with non-clinician staff at the AVAMC on their retention in HIV care. The third quote is an excerpt from an IC participant describing the perception that the IDC staff at the AVAMC play a crucial role in participants’ sense of support, especially compared to VAMC facilities in other cities. This is not intended to be an exhaustive list of the excerpts from the qualitative data. Instead, this quote was selected because they best captured the overall themes expressed by participants in each group.