Table 1 Key themes pertaining to HIV care

Point-of-care HIV testing

“That’s the only time [incarcerated] when I get tested [for HIV]. I do not go to no doctor. Because I be too busy getting high. When I get a place and I’m sober and at a stable mind, maybe I could get tested. When they come around in the jail, and ask me, I am here, why not..”

“I am not gonna go to no building and get tested because I do not have the time for that. My time would be to get out [active substance use]. If that mobile van is sitting out there, and they telling me that’s what it’s [HIV testing] for, I will go in there. It will ease my consciousness.”

Integrated addiction treatment and HIV care

“I was on suboxone illegally. I was buying it on the streets until I saw my HIV doctor, and I explained to him, my situation that I was buying suboxone in the streets. He told me ‘Why you ain’t tell me? I could prescribe it you.’ So I am like great and I always gave him clean urine. I wasn’t getting high as much.”

“It was easy because the methadone program I was in, they was helping me with [HIV] treatment as soon as possible. They wanted to get me into it.”

Non-adherence to ART

“It’s like just not a caring attitude, I am here, and my medicine over there. Just like that because I am running. I am in this city, that town, Baltimore, might be in Jersey, Georgia, to New York in like a 8 days span.”

Stigma related to HIV

“… I had a great job. I was making $23 an hour. My supervisor sees me at the locker one day and I was taking my medication. And I guess she thought I was doing drugs so she was like what you doing. I said I am taking my medications, retrovirals. And after that they started treating me different at work. And so I lost my job. They did not say I lost it [employment] because I have HIV, but they found other reasons.”

“Yes, a lot of people will not admit it [HIV status]. Like my HIV, I have been celibate for 5 years. If I have sex with anyone, I will have to tell that person, listen, this is what I have. But I am not ready to expose myself to anybody. So, I just leave it alone.”

Stigma related to OUD

“With the case manager in the building [HIV/AIDS Service Administration Supportive Housing], she do not really care about nothing, you know. She is just there to maintain the building. Instead of trying to help me with the problem [OUD], she tried to downgrade me, you know. She told me, ‘well I know you guys are getting high here in the building, and you guys got to do something because we are going to start cleaning the house and this and that.’ Instead of saying ‘let me speak to you, you gotta problem, talk to me, you getting high, talk to me, can I help you in anyway?’ She do not do that.”

“When I came to the emergency room, she [nurse] asked me for my ID. I said I do not have no ID because somebody stole it. She asked me, why I came here? I explained [for detoxification from opioids]. She tried to act like she do not want to believe me. That makes me mad. Trying to make me feel like I’m lying to you. That’s why a lot of people do not go to detox. They die in the street instead of coming to the detox and not be humiliated like that.”

Medicaid restrictions to clinical care

“My Medicaid, this was the big problem. I told them that hospital’s been closed for 2 years. I do not understand why I’ve been restricted to a hospital that’s closed.”

“My doctor is restricted to [specific Medicaid plan] I’m restricted to one pharmacy on [location], and now that I live in [distant location from pharmacy], it’s a problem.”