In the midst of plenty: Experiences of food insecurity amongst women living with HIV in Vancouver, Canada.

Globally, people living with HIV (PLWH) are disproportionately affected by food insecurity. Yet there is limited understanding of the impacts of food insecurity among cisgender and transgender women living with HIV (WLWH) in high-income countries. Thus, it is critical to examine the lived experiences of WLWH and food insecurity to inform policy and service provision. As part of the community-based SHAWNA (Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment) study, we conducted 64 semistructured qualitative interviews with WLWH in Vancouver, Canada (2015-2017). Drawing on a socio-ecological framework, this analysis explores the lived experiences of navigating food security and health among WLWH in Metro Vancouver. Our findings indicate that WLWH relied heavily on food banks and other food-related supportive services. Despite the abundance of programs, access to nutritious foods remained difficult, and women often relied on processed foods that were more affordable and readily available. For many, food insecurity was exacerbated by unresponsive food services regulations that did not reflect the actual needs of food service users in terms of opening hours and locations, and a lack of nutritious food. Additionally, the absence of trauma-aware, women-centred and culturally responsive services, as well as, spatial and material barriers related to the recent loss of funding for HIV-specific support services, impeded food security among WLWH. Our findings emphasise that recognizing and addressing the social and structural disparities that exist for WLWH in high-income setting are essential for addressing food insecurity and ultimately optimal health among this population.