Background: Guanica, Puerto Rico, has one of the highest concentrations of environmental polychlorinated biphenyls (PCBs). This PCB contamination coupled with persistent poverty, population loss, and repeated environmental disasters has taken a heavier toll on Guanica community. Our environmental sampling has documented high levels of PCBs in sediment, air and fish, but far less is known about how residents themselves understand exposure, interpret health risk, and weigh contamination against the other pressures of daily life. Methods: We used a qualitative descriptive design nested within the larger HELP Study. This paper presents the final analysis of all qualitative data collected in Guanica: ten sessions comprising five focus groups and five interviews with fishermen (N = 31), conducted between November 2024 and October 2025 in familiar community settings. Sessions followed a semi-structured guide translated from English to Spanish and back-translated for accuracy. Recordings were transcribed in Spanish, verified against the audio, and analyzed in NVivo using codebook-style thematic analysis; three bilingual researchers coded collaboratively and resolved disagreements by consensus. Results: Five themes emerged from our analysis concerning how residents and fishermen understand and navigate PCB contamination: (1) perceived community decline shapes how residents prioritize environmental risks; (2) limited knowledge, misinformation, and communication gaps affect understanding of PCB contamination; (3) cancer concerns are high, but links to PCB exposure remain unclear; (4) PCB contamination is seen as a threat to livelihoods, especially fishing and tourism; and (5) deep mistrust and a desire for accountability influence perceptions of environmental interventions. Participants described contamination not as an isolated hazard but as one strand of a longer history of economic decline, disaster, and institutional neglect. Conclusions: Social, economic, and environmental conditions together shape how Guanica residents perceive contamination of their environment. Meaningful progress requires sustained community involvement, support for local initiatives, development of a Community Health Worker program, and expanded partnerships with local institutions and schools to close communication gaps and promote long-term resilience to address the health effects of PCB contamination in Guanica.