People with HIV in the Southern United States face three intersecting, modifiable barriers to cardiovascular disease prevention: the high cost of healthy food, unsafe or poorly designed environments limiting physical activity, and family or peer norms reinforcing unhealthy behaviors.
Key Findings
Results
The high cost of healthy food was identified as a major barrier to cardiovascular disease prevention among people with HIV in the Southern United States.
Identified through photo-elicitation integrated with semi-structured interviews across three HIV clinics in the Southern United States
Participants documented and interpreted their experiences related to diet, physical activity, lifestyle behaviors, and health monitoring
Food insecurity was mapped to the 'economic stability' determinant domain
Authors recommend embedding food insecurity screening within HIV care to address this barrier
Results
Unsafe or poorly designed neighborhood environments were identified as a barrier limiting physical activity among people with HIV.
This barrier was mapped to the 'neighborhood and environment' determinant domain
Participants used photo-elicitation to document environmental factors shaping their physical activity behaviors
Authors recommend context-tailored activity counseling as a response to this structural barrier
This barrier was characterized as one of three intersecting, modifiable barriers
Results
Family and peer norms reinforcing unhealthy behaviors were identified as a social barrier to cardiovascular disease prevention among people with HIV.
This barrier was mapped to the 'social and community context' determinant domain
Authors recommend family engagement strategies as part of HIV care to address this barrier
This social barrier intersected with economic and environmental barriers
The finding underscores the role of social networks in shaping cardiometabolic health behaviors
Methods
The study sample was predominantly African American/Black, older, and long-term HIV survivors with at least one cardiometabolic condition.
Twenty people with HIV participated, each aged ≥ 35 years and living with at least one cardiometabolic condition
Median age of participants was 57 years
Participants were predominantly African American/Black
Most participants had been living with HIV for more than 10 years
Participants were recruited from three HIV clinics in the Southern United States
Methods
Thematic analysis organized barriers and facilitators across five social determinant domains: economic stability, neighborhood and environment, social and community context, education, and healthcare access and quality.
A qualitative descriptive study design was used
Photo-elicitation integrated with semi-structured interviews was the primary data collection method
The five domains served as a framework for mapping findings to structural and social determinants of health
Determinants were characterized as shaping cardiovascular preventive health behaviors among people with HIV
Background
People with HIV remain at elevated risk for hypertension, diabetes, and cardiovascular disease despite effective antiretroviral therapy, and HIV care models often prioritize viral suppression over integrated cardiovascular prevention.
Progress toward UNAIDS 95-95-95 goals has transformed HIV into a chronic, manageable condition
Cardiometabolic disease has emerged as 'a critical determinant of long-term health among people living with HIV'
The gap between viral suppression-focused care and cardiovascular prevention motivated the study
The study aimed to inform development of interventions that promote sustained health outcomes
Conclusions
The authors recommend embedding food insecurity screening, context-tailored activity counseling, family engagement strategies, and structural supports within HIV care to advance equitable cardiovascular prevention.
Recommendations were derived from the three identified intersecting, modifiable barriers
The authors frame these as necessary to advance 'equitable cardiovascular prevention for people with HIV'
Structural supports are highlighted alongside individual-level counseling strategies
The recommendations are positioned as applicable to HIV clinic settings in the Southern United States
What This Means
This research examined why people living with HIV in the Southern United States struggle to prevent heart disease and other cardiovascular conditions. The study used a creative method called photo-elicitation, where 20 participants took photographs of their daily lives and then discussed those images in interviews. All participants were at least 35 years old, had HIV along with at least one heart-related condition like high blood pressure or diabetes, and most had been living with HIV for over a decade. The majority were African American or Black, and the median age was 57.
The study found three main overlapping obstacles to heart-healthy behavior: healthy food is too expensive, neighborhoods are unsafe or lack spaces for exercise, and family and friends often encourage unhealthy eating and lifestyle habits. These barriers were not seen as individual failures but as rooted in broader social and structural conditions — including economic hardship, the built environment, and the influence of social networks. Importantly, HIV medical care in these settings tends to focus on keeping the virus under control rather than addressing heart disease risk, leaving a gap in comprehensive care.
This research suggests that HIV clinics in the South could better serve their patients by screening for food insecurity, providing physical activity advice tailored to local neighborhood conditions, involving family members in health conversations, and connecting patients to structural resources. As HIV has become a manageable chronic condition, the focus of care needs to expand beyond viral suppression to include long-term cardiovascular health, particularly for Black communities in the South who face compounding health inequities.
Kwawuvi J, Reif S, McKenna K, Dombeck C, Perry M, Iradukunda J, et al.. (2026). Barriers and facilitators of cardiovascular disease prevention among people with HIV in the Southern United States: a photo-elicitation study.. HIV research & clinical practice. https://doi.org/10.1080/25787489.2026.2722768