Ethnographic observation consisted of participant observation at each of the three identified sites (community-based, HIV/AIDS medical center, community service board) and the local rural community. The researcherphysically observed each site. Activities observed included patient flow, staff/patient interactions, the layout of the physical space, wait times, local hangouts, and the layout and distance of the health organization from the community. Field notes were takenduring the entire duration of the project. Upon completion of ethnographic observations of all three study sites (e.g. community-based, HIV/AIDS medical center, community services board) a geographic assessment was mapped to determine the relationship between organizational location, other organizations that the three organizations refer to and the communities served. Field notes and maps were entered into the data base and simultaneously analyzed utilizing Atlas Ti software.
Six central research questionsincluded (1) What are the
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Individual level factors were identified including, (1) traumatic events, (2) medication adherence (or lack of), (3) miseducation about AIDS, and (4) other chronic health issues. Structural level factors were reported at two different levels. The first level was described by individual experiences within the systems. These experiences involved (1) issues with the current physical, mental and behavioral health systems, (2) stigma, and (3) confidentiality breeches. The second level of structural factors surfaced through descriptions from frontline service workers. . Frontline service workers described (1) conflicting organizational missions, and (2) lack of coordination of services between organizations. We conclude by highlighting PLWHA and frontline service worker’s recommendations for linking rural PLWHA into care and sustaining that