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Table 3 Emerging themes organized by food environment domains with example behaviors

From: Exploring drivers of food choice among PLHIV and their families in a peri-urban Dar es Salaam, Tanzania

FOOD ENVIRONMENT DOMAIN

EMERGING THEME

EXTERNAL

Food prices: There were constant price fluctuations of food that were the primary driver of food purchase decisions.

Food vendors: Purchase locations provided PLHIV and their families food on credit to pay back later, when they found work, so they would avoid going without eating.

Food availability: It was difficult to plan food purchases in advance as the foods that were available for purchase differed by day.

HOUSEHOLD/ FAMILY

Gender: Women caregivers would forgo their own food needs and preferences to prioritize the needs of the PLHIV.

Disclosure and knowledge: Within this disclosed population, family members knew that PLHIV needed to take their ARV medications with food to reduce side effects and improve the effectiveness of the medication.

Allocation decisions: were made within the family to improve the diet of the PLHIV.

 • Especially with increased disease severity, family members would forgo their preferences to increase the food consumption and dietary quality of the PLHIV.

 • Cooking resources (one pot, fuel, water), time use, and affordability limited overall family food choice. Despite these constraints, PLHIV were often given a bigger portions and more desired foods.

 • Nutritious foods recommended by healthcare professionals were purchased for the PLHIV.

 • Families made food substitutions to reduce expenditure wherever possible.

Extended networks helped to reduce resource insecurities and ameliorate extreme economic hardships.

 • Drawing on kin

 • Buying food with loans or on credit

PERSONAL

Desirability:

 • Preferred foods were chosen based on emotional connections (traditional, cultural, tribally relevant foods), specific tastes and smells but less on texture and appearance.

 • Change in food preferences over time with diagnosis and disease progression.

 • Gender differences exist in the perception of “healthy” foods.