BACKGROUND: Optimized treatment regimens have improved the survival of children/youth living with HIV (YLH) allowing them to pursue career goals. More YLH are now spending time in schools, but evidence points to poor support and adherence challenges in schools. We explored school staff experiences with YLH in the school environment. METHODS: Four focus group discussions included 32 school staff from 32 high/secondary schools in Kenya. Inclusion criteria included having health responsibilities. Interview data were analyzed using directed content analysis. RESULTS: The median age of participants was 35 (IQR: 31, 45) years and over half were female (56%). The majority of participants (91%) had both teaching and health roles, and half were staff at boarding schools. School staff reported YLH expressing feelings of hopelessness that resulted in medication non-adherence and demotivation to excel in school. Sometimes, YLH HIV status was only disclosed when YLH were referred for disciplinary action due to behavioral problems. Parent/caregiver psychological challenges and difficult home environments made it difficult for schools to work with families to support YLH. School staff often stepped in to offer psychological support to YLH, but this created significant time demands. School staff felt they were not adequately trained to provide the services that YLH needed and advocated for schoolwide staff training on HIV and management of common psychological problems. CONCLUSION: To support YLH to achieve their full potential, there is a need to support school staff to gain the skills needed to support YLH health. Future work on addressing psychological and social health challenges in schools is warranted.