The social-ecological model proposes that efforts to modify health behaviors are influenced by constraints and facilitators at multiple levels. We conducted semi-structured interviews with 47 clients in HIV care and 8 HIV clinic staff to explore how such constraints and facilitators (individual, social environment, physical environment, and policies) affect engaging in HIV clinical care in Nakivale Refugee Settlement in Uganda. Thematic analysis revealed that participants were motivated to attend the HIV clinic because of the perceived quality of services and the belief that antiretroviral therapy improves health. Barriers to clinic attendance included distance, cost, unemployment, and climate. Those that disclosed their status had help in overcoming barriers to HIV care. Nondisclosure and stigma disrupted community support in overcoming these obstacles. Interventions to facilitate safe disclosure, mobilize social support, and provide more flexible HIV services may help overcome barriers to HIV care in this setting.

社会生态模型提出，改变健康行为的努力受到多个层面的约束和促进者的影响。我们与47位HIV护理客户和8位HIV诊所工作人员进行了半结构化访谈，以探讨这种制约因素和促进因素（个人，社会环境，自然环境和政策）如何影响乌干达纳基维尔难民定居点的HIV临床护理。主题分析表明，由于感知到的服务质量以及对抗逆转录病毒疗法可改善健康的信念，参与者被激励参加艾滋病诊所。诊所出勤的障碍包括距离，成本，失业和气候。那些透露自己身份的人有助于克服艾滋病毒治疗的障碍。保密和污名化破坏了社区克服这些障碍的支持。有助于安全披露，动员社会支持并提供更灵活的HIV服务的干预措施可能有助于克服这种情况下的HIV护理障碍。