Table 6 Joint display to compare, contrast, integrate, and interpret findings

More than half (53.9%) had used tobacco products, 38.4% used at a moderate-risk, and 4% at a high-risk level

Tobacco use did not interfere with HIV management or other life goals but was described as very hard to quit. Results suggested that participants wished to stop using tobacco products for health reasons

Qualitative results added context to quantitative results. Interventions to support smoking cessation are needed

Cannabis was used at a moderate-risk level by 51%, and a high-risk level by 9%, 61.5% of those with non-suppressed viral load used cannabis at a moderate-risk level (compared to 49% among those with viral suppression), and cannabis use at a high-risk level seemed to be associated with reduced odds of HIV viral suppression in the multivariable analysis

Cannabis use was common but was not described as a problem and did not appear to interfere with HIV management or other behaviors. Participants often switched from other drugs to cannabis, which can be seen as a form of harm reduction

Quantitative and qualitative results were consistent in that cannabis was common in both sets of results, but discrepant in that the main qualitative results did not suggest cannabis conferred risk to participants. The proportion of those with cannabis use at a high-risk level is small

Twenty-two percent had used methamphetamine in their lifetimes. Methamphetamine use may be higher among those not virally suppressed compared to those suppressed (37% vs. 18%)

Methamphetamine, when reported, generally had serious adverse effects on participants’ lives and was challenging to stop. Formal substance use treatment was often needed to reduce or stop methamphetamine use, often more than once

Qualitative results added context to quantitative results

Lifetime substance use was reported among the participants: 35.4% reported using tobacco in their lifetime, 79.3% reported alcohol use, 68.3% reported cannabis use, 24.4% reported cocaine use, 35.4% reported using inhalants, 21.8% reported using methamphetamine, and 28.4% reported using hallucinogens

Participants shared their experiences of using substances in various social settings, often for recreational purposes. Some participants talked about experiencing heavy substance use at certain points in their lives and later transitioning to abstinence or reducing their substance use as a form of harm reduction

Qualitative results added context to quantitative results

Substance use treatment was less common than mental health treatment but the prevalence of treatment was low overall

Participants discussed substance use treatment more commonly than mental health treatment. Marijuana was described as useful for mental health symptoms. It was not possible to determine if treatment needs were generally met from this data set

Qualitative results added context to quantitative results and results were discrepant to some extent. It is possible substance use treatment is more prominent in participants’ minds than mental health care because substance use problems can have serious adverse effects on their lives and treatment is not sought until problems are serious

Providers’ role in managing substance use was not assessed

Participants who discussed substance use with their healthcare providers reported receiving positive and supportive responses from them

Regarding discussing substance use with providers, this may reflect a strength-based strategy and highlights the critical role that providers have in facilitating engagement and support for individuals navigating their HIV care

The prevalence of positive anticipated future life outcomes was modest overall particularly for social domains (e.g., about half expected to have a long-term love relationship and good family relationships) and longevity. Those with non-suppressed viral load appear to have lower rates of positive outcome expectancies in some domains (e.g., long-term love relationship)

Discussion of anticipated future life outcomes was found in the data but was not common. In general participants appeared optimistic about their futures and were striving to achieve goals. It was not clear from the qualitative data whether or how anticipated future life outcomes related to HIV management, but substance use could interfere with goals

Qualitative data do not contradict quantitative data but research questions remain

PHQ-8 depression index was 7.3 (SD = 6.1) with a range from 0–24 (so rates of depressive symptoms were low overall) and comparable in the suppressed and non-suppressed subgroups

Depression was commonly discussed in relationship to the HIV diagnosis and ongoing HIV management, along with other life events and life stressors. Depression could interfere with HIV management and drive substance use as a way of coping. Participants appeared to find ways to mitigate depression

Qualitative results added context to quantitative results. Quantitative data are current depressive symptoms while qualitative are current and retrospective

The average score on the PTSD index was 1.7 (SD = 1.6) with a range from 0–4 so rates of PTSD symptoms were low overall) and comparable in the suppressed and non-suppressed subgroups

The qualitative data did not specifically identify PTSD but trauma and its various effects were mentioned, and contributed to substance use, which in turn could interfere with HIV management. Participants experienced early childhood and family trauma, trauma migrating to the US, and the HIV diagnosis was often experienced as traumatic or close to it

Qualitative results added context to quantitative results

PHQ-8 depression scores and PTSD scores seemed to reduce the odds of being well-engaged in care

As noted above, mental health symptoms were described as impeding HIV management and results provided insights into how this took place including by triggering substance use. HIV medication was more commonly discussed than HIV care

Qualitative results added context to quantitative results

No age effect in logistic regressions

Qualitative results suggested that participants improve in their abilities to substance use and mental health over time, since the most problematic periods for them were in the past. Participants discussed learning how to manage substance use, mental health, and HIV better over time

Quantitative and qualitative results were discrepant in some respects, although quantitative data are not ideal for capturing change over time. Since mental health disorders and substance use problems can be recurring, preventive interventions are needed

Spirituality was not assessed in the quantitative assessment battery

Spirituality could be an important source of hope. Engagement in organized religion was not common

Qualitative data fill a gap in this paper