Background <p>Methamphetamine use continues to disproportionately affect sexual and gender minority (SGM) communities and is associated with physical, mental, and sexual health harms, including heightened HIV vulnerability. While prior epidemic waves have been well documented, the current resurgence (particularly among SGM individuals), remains underexplored and occurs within an evolving HIV prevention landscape. Persistent challenges within the substance use disorder care continuum (SUDCC), including stigma and limited treatment responsiveness, underscore the need for patient-centered clinical guidance. This study examines treatment navigation experiences of SGM individuals who use methamphetamine and their recommendations for improving their substance use care.</p> Methods <p>Participants were recruited from a U.S. national HIV prevention cohort that oversampled for individuals reporting recent methamphetamine use. Twenty-nine participants completed semi-structured, in-depth interviews between December 2024 and January 2025. Interviews focused on healthcare experiences, treatment navigation, and participants’ recommendations for SUDCC stakeholders. Interviews were recorded and transcribed verbatim into written transcripts, which were analyzed using a codebook approach to thematic analysis.</p> Results <p>Our findings were organized into four major themes: (1) <i>Variation in Motivation to Use Meth</i>, (2) <i>Need for Destigmatized Care</i>, (3) <i>Desire for SGM-Affirming Care</i>, and (4) <i>A Spectrum of Care Needs</i>. Participants reported a variety of motivations for using meth, including to enhance their sex lives, cognition, and emotion regulation—motivations that providers may benefit from understanding as they aim to address the overlapping physical and psychosocial health needs of patients who use methamphetamine. The importance of reducing stigma in clinical encounters was underscored frequently by participants, and represented a salient theme throughout interviews and across thematic categories. Participants described both experienced and anticipated stigma when underscoring the need for de-stigmatized substance use care, and illustrated how stigma hindered substance use care engagement and use of emergency services. Moreover, many reported a desire for community among other SGM individuals, particularly within group recovery contexts, but also elucidated the risks that accompanied drug network expansion within these treatment environments.</p> Conclusion <p>This study advances the substance use and treatment literature by amplifying the voices of SGM individuals who use methamphetamine and providing guidance for providers who work directly with these populations.</p>