This study explores utilization of treatment for HIV and barriers to care among 22 low-income adults of color who were hospitalized at an urban medical center in New York City. A semistructured interview assessing use of medical care and adherence to HIV medications, psychosocial stressors (e.g., social support, substance abuse, and mental health need), and logistical, perceptual, and environmental barriers to treatment was administered during the participants' hospital stay. Results showed that most of the sample had a regular source of outpatient care; however, very few were consistently connected to services. Further, the majority of respondents either skipped dosages or was not taking HIV medications all together. Untreated mental health and substance abuse difficulties, competing needs (e.g., housing, economic), unsafe living environments, negative views of treatment, and lack of social support were cited as contributing to treatment underuse. These findings suggest highly disadvantaged populations face innumerable obstacles to consistent receipt of needed care: implications and potential methods to intervene are discussed.