Abstract
BACKGROUND: HIV/AIDS continues to pose a significant public health challenge globally and in India, despite the availability of free antiretroviral therapy (ART) through government healthcare services. People living with HIV (PLHIV) often face multiple barriers that limit their access to essential treatment and care. Understanding these barriers—particularly those rooted in the community, health system, socioeconomic status, and personal factors—is crucial for improving service delivery and treatment adherence. METHODS: This mixed-methods study was conducted over a ten-month period (February to December 2023) at an ART center in Jharkhand, India. A total of 139 PLHIV were enrolled for the quantitative component, where data were collected via a pretested structured questionnaire. Statistical analysis was performed via Jamovi (version 2.2.5) to identify associations between demographic factors and reported barriers. For the qualitative component, in-depth interviews (IDIs) were conducted with PLHIV and key ART center stakeholders. Data were analyzed via content analysis in ATLAS.ti (free trial version) and visualized via word clouds to highlight dominant themes. RESULTS: Approximately half of the participants were male, urban residents with primary-level education. Community-level barriers prominently included stigma and fear of social exclusion. Health system barriers include drug stock-outs, lack of trust in healthcare providers, and long waiting times at ART centers. Socioeconomic challenges such as wage loss and unaffordable transportation further hinder access. Statistically significant associations were found between gender and place of residence with both health system and socioeconomic barriers. Qualitative insights complemented these findings, providing context-specific accounts of the challenges faced by PLHIV. CONCLUSION: PLHIV in Jharkhand face a complex interplay of community, health system, socioeconomic, and personal barriers that limit their access to ART services. These findings underscore the need for a multipronged approach that addresses structural, economic, and social determinants to improve service uptake and adherence among PLHIV. TRIAL REGISTRATION: Not applicable, as this was an observational study without intervention. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-026-27074-0.