This qualitative study explored perceptions and experiences of HIV-positive rural African American women regarding availability, accessibility, and quality of health care and social services. Twenty-two women residing in rural areas of South Carolina were recruited to participate in one of three focus groups. A conceptual model of health services utilization was used to guide the study and served as a framework for coding data. Verbatim transcripts of group discussions were analyzed using content analysis to code and identify data categories. Data revealed common perceptions of lack of services and inferior quality of available services to meet some of their most important needs. Overall, findings provide a picture of women whom the health care/social services system fails to serve. The findings have significant implications for increasing resources and designing interventions that empower these women and enhance their quality of life.