title: Use, perceptions, and acceptability of a ready-to-use supplementary food among adult HIV patients initiating antiretroviral treatment: a qualitative study in Ethiopia.
abstract: OBJECTIVE
  Ready-to-use supplementary foods (RUSF) are used increasingly in human immunodeficiency virus (HIV) programs, but little is known about how it is used and viewed by patients. We used qualitative methods to explore the use, perceptions, and acceptability of RUSF among adult HIV patients in Jimma, Ethiopia.
  
  
  METHODS
  The study obtained data from direct observations and 24 in-depth interviews with HIV patients receiving RUSF.
  
  
  RESULTS
  Participants were generally very motivated to take RUSF and viewed it as beneficial. RUSF was described as a means to fill a nutritional gap, to "rebuild the body," and protect it from harmful effects of antiretroviral treatment (ART). Many experienced nausea and vomiting when starting the supplement. This caused some to stop supplementation, but the majority adapted to RUSF. The supplement was eaten separately from meal situations and only had a little influence on household food practices. RUSF was described as food with "medicinal qualities," which meant that many social and religious conventions related to food did not apply to it. The main concerns about RUSF related to the risk of HIV disclosure and its social consequences.
  
  
  CONCLUSIONS
  HIV patients view RUSF in a context of competing livelihood needs. RUSF intake was motivated by a strong wish to get well, while the risk of HIV disclosure caused concerns. Despite the motivation for improving health, the preservation of social networks was prioritized, and nondisclosure was often a necessary strategy. Food sharing and religious fasting practices were not barriers to the acceptability of RUSF. This study highlights the importance of ensuring that supplementation strategies, like other HIV services, are compatible with the sociocultural context of patients.
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark.
authors.forename: Mette Frahm
authors.initials: MF
authors.lastname: Olsen
authors.forename: Markos
authors.initials: M
authors.lastname: Tesfaye
authors.forename: Pernille
authors.initials: P
authors.lastname: Kaestel
authors.forename: Henrik
authors.initials: H
authors.lastname: Friis
authors.forename: Lotte
authors.initials: L
authors.lastname: Holm
keywords: Africa; adherence; nutritional supplementation; qualitative research