As of July 2015, over 15 million people worldwide were undergoing lifesaving antiretroviral therapy to treat HIV, marking the achievement of an important Millennium Development Goal. More research is needed to determine sustainable interventions to engage patients in HIV care. We explored the perceptions, facilitators, and barriers of engagement in HIV care among people living with HIV. Fourteen patients participated in a focus group and in-depth interviews to propagate our understanding of participants' readiness to engage and remain in HIV care. The themes that emerged were a desire to live and stay well, positive influence from support systems, struggles with mental and physical illness, safe haven in clinic and with staff, system reminders to stay in care, life gets in the way, struggles with alcohol and drugs, and a desire to feel needed. This study provides preliminary data designed to increase engagement and retention in care critical in the HIV Care Continuum for models of high-impact prevention.