“Food engages people, as we know”: health care and service providers’ experiences of using food as an incentive in HIV care and support in British Columbia, Canada

ABSTRACT

Food insecurity is widely documented among people living with HIV (PLWH) worldwide, and it presents significant challenges across the spectrum of HIV care and support. In North America, the prevalence of food insecurity among PLWH exceeds 50%. In the province of British Columbia (BC), it exceeds 65%. It comes as no surprise that food has become an essential tool in supporting and engaging with PLWH. Over the past decade, however, a shift has taken place, and food has become an incentive to boost uptake and outcomes of prevention, testing, treatment, and support. To explore this practice, we drew on a qualitative case study of incentives in the care and support of PLWH. This paper presents the findings of a targeted analysis of interviews (N = 25) that discuss food incentives and explores two main themes that shed light on this practice: (1) Using food to engage versus to incentivize and (2) Food is more beneficial and more ethical. Providers perceived food more positively than other incentives, despite the goal remaining somewhat the same. Incentives, such as cash or gift cards, were considered ethically problematic and less helpful (and potentially harmful), whereas food addressed a basic need and felt more ethical.

KEYWORDS:

• Food
• HIV
• incentive
• providers
• case study

Acknowledgements

We would like to thank all the providers who contributed to the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contributions

MG, AG, and VB designed the case study. MG conducted the interviews. AP extracted the food-related data and led the literature review. AP completed the initial coding of the data and worked with MG to finalize the themes. MG wrote the manuscript. AP, AG and VB revised the manuscript and contributed to the discussion. All authors read and approved of the final version.

Ethics and consent to participate

This study was reviewed and approved by the Research Ethics Board of the University of Victoria and the University of Windsor.

Availability of data and materials

In order to protect the confidentiality and anonymity of participants, the data (transcripts) will not be shared.

Notes

1 Food insecurity is the experience of lacking “physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life” (Anema, Fielden et al., 2014, p. 478).

Additional information

Funding

This study was funded by the Canadian Institutes of Health Research, Grant # 159826.