The Middle East and North Africa (MENA) region is facing a rise in HIV prevalence due to inadequate political commitment, stigma, and the criminalization of key populations (KPs). A study analyzing the experiences of KPs and people living with HIV (PLHIV) used a convergent mixed-methods approach, collecting data from an online survey of 100 participants and qualitative interviews with 38 individuals across Arabic-speaking MENA. Findings revealed that many view their socio-legal environment as hostile, leading them to focus on structural challenges and survival rather than accessing HIV services. The most pressing issues identified were social and familial violence, criminalization, and poverty, while access to medical services was seen as a lesser concern. Participants expressed a strong need for advocacy focused on law and policy reform, with a demand for pro bono legal aid and mental health support. The research underscores a gap between the realities faced by the community and the current medical response to HIV, calling for funders and policymakers to shift from a limited service delivery approach to a broader human rights framework that emphasizes legal reform and overall security for affected populations.