. 2022 Mar 19;18:17455057221083809. doi: 10.1177/17455057221083809

Table 3.

Exemplary quotes for theme 3: proposed solutions: piecing together individual, social, and organizational interventions to increase access to HIV care that may benefit women living with HIV of all genders but are disproportionately framed for cis women.

Quote
Individual-level interventions, “personal” work to enact person-centered care: “I think, for me, it’s not about going to classes and learning how—people say, “Oh, we should do a cultural diversity class.” I think that’s a—well, what I learn or how I treat patients is I learn from my patients . . . .” (P6, Physician) Individual-level interventions, “personal” work to enact person-centered care: “I’m white. I’m not Black. I have tried to, like, in college and in medical school I lived in the city in a low-income Black neighborhood and tried to participate in the neighborhood that I lived in . . . . I tried to build relationships that are genuine and real friendship with individuals of African-American descent that, I mean, in the city outside of work . . . . I think that having real relationships with people that are of the same background as the patients that I see, I think is helpful to have some sensitivity of their life experiences.” (P2, Physician) Social-level interventions, women-specific support groups: “It would be nice—I guess the support piece of it, to be able to bring women together more to talk to each other . . . .” (P13, Social Service Provider) Social-level interventions, women-specific support groups: “I would say is I think it would be nice to have maybe programs that are specific to women just ’cause again, the face of HIV is very much white gay male . . . . I think support groups or having something in place for women living with HIV to come together would be amazing. That way there is a sense of comradery and community as well.” (P3, Social Service Provider) Organizational-level interventions, hiring staff who are reflective of communities and partnering with affirming providers: “Currently our patient navigators are not [people living with HIV], but they are people that have an identity within the community serve[d]. They’re not positive, but on a face value, I guess they look like the people they’re serving . . . . We are very cognizant of our organization about—because we understand how representation and feeling seen can be a barrier. We are very cognizant of having people that look like the people we are serving, that are part of the same community, to try to decrease that barrier . . . . We have people [staff] that are gender non-conforming so using neutral pronouns.” (P7, Social Service Provider) Organizational-level interventions, hiring staff who are reflective of communities and partnering with affirming providers: “Really, for us, finding that primary care doctor who is LGBT-friendly and knowledgeable and trans-competent has been great for our clients. I think once you can get clients into primary care, their hormones are being taken care of, if they wish to be on hormones, because it’s that basic need. Then they can really start thinking about getting their HIV under control, taking the medications, and that sort of thing. It’s like that hierarchy of needs, again, ’cause once we can build that relationship and get them stable in a lot of these other areas, then we can also help them be stable in their HIV care.” (P12, Social Service Provider) Organizational-level interventions, hiring staff who are reflective of communities and partnering with affirming providers: “A lot of times, especially with the trans community, a lot of it is the word of mouth, honestly. Then people doing outreach, building those relationships, continuing to cultivate those relationships and listening to the people that are going . . . .” (P7, Social Service Provider) Organizational-level interventions, community advisory boards: “We also do a community advisory board, but it’s also a social support group although it’s not really the mission of the group but the objective is that that’s what it’s become. But I think it’s been helpful to get to know them and also provide a place for them to support each other. I would love to do more with those community advisory groups and ’cause I think it’s been really helpful for the patients to come together to talk about their shared experience.” (P2, Physician) Organizational-level interventions, community advisory boards: “We even do different things getting outside of the women, for instance, we have actually a women support group where we have women coming in and they meet together. Then they discuss different issues that go on, because we have a general support group like a community—what is it called? CAG, Community Activity Group or whatever. It’s basically patients who come together to talk about different issues about their treatment, about things that they would like to see in there. Then we meet together.” (P5, Physician) Organizational-level interventions, comprehensive care: “I mean, if I had a dream clinic, that would provide optimal care for women with HIV, I think that would look like, number one, having the ability to have a gynecologist onsite in our clinic to provide a lot of the women’s healthcare issues, whether it’s Pap Smear, breast exam, mammogram, all of those types of things . . . . Then, oh, the other issue that would be great, again, having a gynecologist in clinic, is pregnancy prevention. Providing Depo-Provera for patients that need it, IUDs, things like that . . . .” (P1, Physician) Organizational-level interventions, comprehensive care: “Also, in a perfect world, there would be childcare provided for mothers to access care. Places where people could go for all-in-one care, and then things like that to help them, especially if they have kids that are not-in-school age, to be able to provide that care for women to be able to get into health.” (P12, Social Service Provider) Organizational-level interventions, comprehensive care: “One thing is, of course, transportation is a big thing for women. The other is childcare. Sometimes not even childcare but care for whoever they’re caring for at home.” (P6, Physician)
Multi-level interventions, provider training: “I’ve had different trainings and met different people, so I think it’s just been an ongoing [issue] through my work learning process. [Trainings,] they’re not always very well attended.” (P13, Social Service Provider) Multi-level interventions, provider training: “Our social workers provide LGBTQ training for our front desk and other staff in the office, so that when patients come in, they feel like it’s a welcoming environment and they don’t feel like there’s stigma there.” (P1, Physician)

Quote

Individual-level interventions, “personal” work to enact person-centered care: “I think, for me, it’s not about going to classes and learning how—people say, “Oh, we should do a cultural diversity class.” I think that’s a—well, what I learn or how I treat patients is I learn from my patients . . . .” (P6, Physician)
Individual-level interventions, “personal” work to enact person-centered care: “I’m white. I’m not Black. I have tried to, like, in college and in medical school I lived in the city in a low-income Black neighborhood and tried to participate in the neighborhood that I lived in . . . . I tried to build relationships that are genuine and real friendship with individuals of African-American descent that, I mean, in the city outside of work . . . . I think that having real relationships with people that are of the same background as the patients that I see, I think is helpful to have some sensitivity of their life experiences.” (P2, Physician)
Social-level interventions, women-specific support groups: “It would be nice—I guess the support piece of it, to be able to bring women together more to talk to each other . . . .” (P13, Social Service Provider)
Social-level interventions, women-specific support groups: “I would say is I think it would be nice to have maybe programs that are specific to women just ’cause again, the face of HIV is very much white gay male . . . . I think support groups or having something in place for women living with HIV to come together would be amazing. That way there is a sense of comradery and community as well.” (P3, Social Service Provider)
Organizational-level interventions, hiring staff who are reflective of communities and partnering with affirming providers: “Currently our patient navigators are not [people living with HIV], but they are people that have an identity within the community serve[d]. They’re not positive, but on a face value, I guess they look like the people they’re serving . . . . We are very cognizant of our organization about—because we understand how representation and feeling seen can be a barrier. We are very cognizant of having people that look like the people we are serving, that are part of the same community, to try to decrease that barrier . . . . We have people [staff] that are gender non-conforming so using neutral pronouns.” (P7, Social Service Provider)
Organizational-level interventions, hiring staff who are reflective of communities and partnering with affirming providers: “Really, for us, finding that primary care doctor who is LGBT-friendly and knowledgeable and trans-competent has been great for our clients. I think once you can get clients into primary care, their hormones are being taken care of, if they wish to be on hormones, because it’s that basic need. Then they can really start thinking about getting their HIV under control, taking the medications, and that sort of thing. It’s like that hierarchy of needs, again, ’cause once we can build that relationship and get them stable in a lot of these other areas, then we can also help them be stable in their HIV care.” (P12, Social Service Provider)
Organizational-level interventions, hiring staff who are reflective of communities and partnering with affirming providers: “A lot of times, especially with the trans community, a lot of it is the word of mouth, honestly. Then people doing outreach, building those relationships, continuing to cultivate those relationships and listening to the people that are going . . . .” (P7, Social Service Provider)
Organizational-level interventions, community advisory boards: “We also do a community advisory board, but it’s also a social support group although it’s not really the mission of the group but the objective is that that’s what it’s become. But I think it’s been helpful to get to know them and also provide a place for them to support each other. I would love to do more with those community advisory groups and ’cause I think it’s been really helpful for the patients to come together to talk about their shared experience.” (P2, Physician)
Organizational-level interventions, community advisory boards: “We even do different things getting outside of the women, for instance, we have actually a women support group where we have women coming in and they meet together. Then they discuss different issues that go on, because we have a general support group like a community—what is it called? CAG, Community Activity Group or whatever. It’s basically patients who come together to talk about different issues about their treatment, about things that they would like to see in there. Then we meet together.” (P5, Physician)
Organizational-level interventions, comprehensive care: “I mean, if I had a dream clinic, that would provide optimal care for women with HIV, I think that would look like, number one, having the ability to have a gynecologist onsite in our clinic to provide a lot of the women’s healthcare issues, whether it’s Pap Smear, breast exam, mammogram, all of those types of things . . . . Then, oh, the other issue that would be great, again, having a gynecologist in clinic, is pregnancy prevention. Providing Depo-Provera for patients that need it, IUDs, things like that . . . .” (P1, Physician)
Organizational-level interventions, comprehensive care: “Also, in a perfect world, there would be childcare provided for mothers to access care. Places where people could go for all-in-one care, and then things like that to help them, especially if they have kids that are not-in-school age, to be able to provide that care for women to be able to get into health.” (P12, Social Service Provider)
Organizational-level interventions, comprehensive care: “One thing is, of course, transportation is a big thing for women. The other is childcare. Sometimes not even childcare but care for whoever they’re caring for at home.” (P6, Physician)

Multi-level interventions, provider training: “I’ve had different trainings and met different people, so I think it’s just been an ongoing [issue] through my work learning process. [Trainings,] they’re not always very well attended.” (P13, Social Service Provider)
Multi-level interventions, provider training: “Our social workers provide LGBTQ training for our front desk and other staff in the office, so that when patients come in, they feel like it’s a welcoming environment and they don’t feel like there’s stigma there.” (P1, Physician)

CAG: Community Activity Group; LGBTQ: lesbian, gay, bisexual, transgender, and queer.