Factors influencing the nutritional health and food choices of African American HIV-positive marginally housed and homeless female substance abusers

The toll of HIV/AIDS and drug abuse on economically disadvantaged women of color in the United States is a public health problem of epidemic proportions. Malnutrition, believed to be pervasive in this population, exacerbates the devastating health effects of addiction and HIV. This study documented dietary deficiencies in this population and examined factors influencing the food choices and eating patterns of marginally housed and homeless African American HIV-positive substance abusing women. Data were collected from 28 women ages 19-55 using two 24-hour dietary recalls and a semistructured interview guide. Data revealed multiple nutritional intake hazards including skipped meals, substitution of carbohydrate-laden foods for dairy foods rich in animal fat and proteins, and an absence of raw fruits and vegetables indicative of deficiencies in key macro and micronutrients. Food risks were increased for homeless women who were more likely to lack public assistance, have difficulty accessing free food service, and frequently eating food from dumpsters. Qualitative data analysis of interviews generated three major themes describing the context in which nutritional deficiencies emerged: (1) diet-disease and food-safety misconceptions; (2) socio-cultural and lifestyle barriers; and (3) lack of personal resources and neighborhood food availability and affordability. The relevance of these findings to nutrition intervention programs for this population is discussed.