Table 3.

Provider Perceptions of Barriers to Care for Women Living with HIV and Policy and Programmatic Implications.

Identified Barrier	Provider Suggestions	Selected Quotations
Fear of disclosure of HIV status	Services to support partner disclosure to prevent violent reactions Provide support for clients who do not receive it from their families or friends due to lack of disclosure Create a safe, supportive environment during office visits	“…we offer to help a woman disclose … we have this psychiatry team… if they think they’re ready, we’ll work with them and we’ll be together with the partner and we’ll monitor so… there's no violence…” [Administrator, Male, 25 years of experience with RWP clients] “A lot of them don't get the care that they need… and since they don't get the care that they need, they don't take medications and then their health deteriorates. That's why it's so important for us to reach out to these women, and say, ‘Hey we’re here to help, if you have any questions you know we are here to support.’ Because if they can't get it from family and friends, they can sure come here at least we can provide some sort of support… so they don't feel alone.” [Medical Case Manager, Female, 19 years of experience with RWP clients] “… they think that it's a stigma on them. They don't want nobody to know it, so you have to make them comfortable to let them know, ‘No, you’re here. Nobody's gonna know … we don't even discuss to our own peers.” My patient[s] come in my office, I will close the room… so we’ll make them feel at home.” [Medical Case Manager, Female, 6 years of experience with RWP clients]
Accidental disclosure through utilization of HIV services	Additional pharmacy options for clients who rely on AIDS Drug Assistance Program (ADAP) Rideshare services that aren't explicitly linked to HIV care Holding support groups in locations that protect participants from being seen or identified by acquaintances	“…if we had more… pharmacy… locations… or options for patients, I think that would be great.” [Medical Case Manager, Female, 5 years of experience with RWP clients] “…they shy away from asking for help when they need it because they’re so afraid that they’re going to be associated with something that is clearly for people living with the virus. …The same way we’re trying to make their healthcare personal but giving them access to things that are personalized for them. Maybe giving them a card every month that allows them to take an Uber, where they don't have to share a ride with everyone and wonder if everyone is gonna know…” [Advanced Registered Nurse Practitioner, Female, 8 years of experience with RWP clients] “…the agency went as far as covering the window panes so they can feel comfortable.” [Medical Case Manager, Female, 19 years of experience with RWP clients]
Lack of transportation	Increased funding for rideshare services that aren't explicitly linked to HIV care	“…having funding where you’re getting 50 dollars or 60 dollars a month, specifically to be able to go to your appointments … Once your 50 bucks is up, then it's up.” [Advanced Registered Nurse Practitioner, Female, 8 years of experience with RWP clients]
Childcare	Formalized childcare areas	“They sit there, if they have to go in or something, they probably say ‘Can you watch my kid?’ and the person in the lobby watches their kid. You know we’re not gonna let nobody come in here and snatch your kid and run off with them like that… I might like to see us develop a childcare area… At least the kid can be somewhere where he's able to color, draw, something, watch cartoons or something… even some type of electronic game where they can sit and play… while their caretaker is in with the provider.” [Medical Case Manager, Female, 19 years of experience with RWP clients]
Conflict with employment	Flexible scheduling and appointment reminders Extended and weekend hours	“We try very hard. I mean we have a great scheduler and we also make phone calls for the week or two before the appointment, so we can talk to them.” [Advanced Registered Nurse Practitioner, Female, 27 years of experience with RWP clients] “Providing healthcare services between our hours of 8 and 5, or even ‘til 6 o’clock is not always reasonable. And not opening from 6 to 10[pm], or on the weekend. So I think those changes could actually make a great impact.” [Medical Case Manager, Female, 12 years of experience with RWP clients]
Lack of social support	Support groups specifically for women with HIV Availability of peer navigators who are women	“…even with Ryan White and everything…[there's] not too many programs out there to help women with HIV. There are a lot of programs to help MSM. But there's not a lot of groups… for women. I don't think that's equal… I think Ryan White should spend some money or start some program that will really… help women, because some of these women work, they’re mothers, they have to deal with partners, they have to deal with children… there's no support.” [Advanced Registered Nurse Practitioner, Female, 25 years of experience with RWP clients] “We wanna hire at least 2 or 3 more female peers… they’re the ones that take their information when the person first comes in, so we’ve had women ask, ‘Hey is there a woman I can speak to?’…we know they might feel more comfortable with a female.” [Medical Case Manager, Female, 19 years of experience with RWP clients]
Culturally rooted Beliefs	Adapt communication/education strategies to be relevant to the client	“…one of my group is my Haitian population…I’ve explained it to them in Creole… ‘HIV is a thief… and it's brought a bunch of its friends… What do thieves do? They rob you … if you allow them they will rob you of your life… your medication, that is the police…the more you take your medication, the more police that come into your body… When you see your viral load, it says 100,000, and your CD4 count is… 200… you got 100,000 thieves versus 200 police. Who's going to win?’ …When they come back…and they see their number is now 100 viral load and their CD4 is 7,000, I say, ‘Look, we got more police officers and less thieves!’” [Advanced Registered Nurse Practitioner, Female, 3 years of experience with RWP clients] “I get to the point where I even draw diagrams for them… showing them how the medication works and different stages of replication.” [Advanced Registered Nurse Practitioner, Female, 8 years of experience with RWP clients]
Interactions with healthcare providers	Providing peer navigators to attend medical appointments with clients to reduce levels of intimidation they may feel Better education for providers on care for people with HIV Diverse workforce Cultural competency, and taking cultural differences into account when providing care Training to reduce bias that goes beyond online modules	“One of things we’re trying to do is if a client asks for a peer educator to go with them to their appointment, we’ll go ahead and we’ll provide that… because sometimes the peer will ask because they already know the doctors.” [Medical Case Manager, Male, 7 years of experience with RWP clients] “We did try to take the culture into perspective, with the understanding the Haitian culture is different from the African American culture which is different from the Latino Hispanic Culture.” [Medical Case Manager, Female, 5 years of experience with RWP clients]

Abbreviations: HIV, human immunodeficiency virus; RWP, Ryan White Program.