People with HIV in the Southern United States face three major barriers to preventing heart disease: expensive healthy food, unsafe neighborhoods that discourage exercise, and family members who model unhealthy behaviors. According to Gram Research analysis of this 20-person qualitative study, these barriers are interconnected and rooted in social and economic systems, not individual failures. HIV clinics should screen for food insecurity, provide neighborhood-specific exercise counseling, and involve families in prevention efforts to help patients stay heart-healthy.
People living with HIV in the Southern United States face unique challenges when trying to prevent heart disease and diabetes, even though modern HIV medications work well. Researchers interviewed 20 people with HIV who also had heart-related health conditions to understand what makes it difficult to eat healthy, exercise, and monitor their health. They found that expensive healthy food, unsafe neighborhoods for walking or exercising, and family habits that encourage unhealthy choices are the biggest obstacles. The study suggests that HIV clinics need to do more than just manage the virus—they should also help patients prevent heart disease by addressing these real-world barriers.
Key Statistics
A photo-elicitation study of 20 people with HIV in the Southern United States found that high cost of healthy food, unsafe or poorly designed environments, and family or peer norms reinforcing unhealthy behaviors were the three main barriers to cardiovascular disease prevention.
In a 2026 qualitative study of 20 participants with HIV and cardiometabolic conditions, researchers found that HIV care models often prioritize viral suppression over integrated cardiovascular prevention, despite people with HIV remaining at elevated risk for hypertension, diabetes, and cardiovascular disease even with effective antiretroviral therapy.
A photo-elicitation study of 20 people with HIV (median age 57, predominantly African American, most living with HIV for over 10 years) identified that structural barriers including food insecurity, neighborhood safety concerns, and lack of social support were modifiable factors that HIV clinics could address to improve cardiovascular prevention.
The Quick Take
- What they studied: What makes it hard for people with HIV to prevent heart disease and diabetes in the Southern United States
- Who participated: 20 people with HIV, average age 57, mostly African American, living with HIV for more than 10 years, all with at least one heart or metabolic condition
- Key finding: Three main barriers prevent people with HIV from staying heart-healthy: expensive healthy food, unsafe neighborhoods that discourage exercise, and family members or friends who model unhealthy behaviors
- What it means for you: If you have HIV and live in the South, your struggles with healthy eating and exercise may not be personal failures—they’re often caused by bigger system problems. HIV clinics should screen for food insecurity and help you find safe ways to be active in your neighborhood
The Research Details
Researchers conducted a qualitative descriptive study, which means they focused on understanding people’s experiences rather than testing a specific treatment. They recruited 20 people with HIV from three HIV clinics in the Southern United States. Each participant had lived with HIV for at least 10 years and had at least one heart-related condition like high blood pressure or diabetes.
The researchers used a creative method called photo-elicitation, where participants took pictures of things related to their daily lives—like the food they eat, places where they exercise, and their home environments. During interviews, participants explained what their photos meant to them and discussed their experiences with diet, physical activity, and health monitoring.
The research team then analyzed all the interviews to find common themes and patterns. They organized their findings into five categories: money and economic stability, neighborhood safety and design, family and community support, education and health knowledge, and access to quality healthcare.
This approach is important because it lets people with HIV tell their own stories in their own words, rather than researchers just asking yes-or-no questions. By using photos, participants could show researchers the real barriers they face every day—like a food desert in their neighborhood or a lack of safe walking paths. This method captures the complexity of people’s lives and reveals why simple advice like ’eat healthier’ or ’exercise more’ often doesn’t work without addressing underlying problems.
This study has several strengths: it focuses on a specific, underserved population (people with HIV in the South), uses a rigorous qualitative method, and includes diverse participants who have lived experience with both HIV and heart disease. However, the study is relatively small (20 people) and focused only on the Southern United States, so findings may not apply everywhere. The study doesn’t measure whether interventions based on these findings actually work—it only identifies barriers. Qualitative research like this is best used to inform future studies and interventions, not to make definitive claims about what will work for everyone.
What the Results Show
The study identified three interconnected barriers that prevent people with HIV from preventing heart disease. First, healthy food is expensive and often unavailable in participants’ neighborhoods. One participant described struggling to afford fresh vegetables and lean proteins while living on a limited income. Second, many participants lived in neighborhoods that weren’t safe for walking or exercising outdoors, with poor street lighting, high crime, or lack of sidewalks and parks. Third, family members and friends often modeled unhealthy behaviors—eating fried foods, not exercising, or not taking medications—which made it harder for participants to make different choices.
These barriers didn’t exist in isolation. For example, a person might want to exercise but couldn’t afford a gym membership and lived in an unsafe neighborhood. Or someone might want to eat healthier but couldn’t afford fresh food and had family members who cooked only fried foods. The researchers found that these barriers were deeply connected to larger social and economic systems, not just individual choices.
Participants also described how their HIV care often focused only on keeping the virus under control, with less attention to preventing heart disease. Many felt they needed more education about how HIV and heart disease are connected, and they wanted their doctors to help them navigate the real-world barriers they faced.
The study revealed that healthcare access and quality varied significantly among participants. Some had supportive doctors who asked about their diet and exercise, while others felt their concerns weren’t taken seriously. Participants also described how their education level affected their ability to understand health information and make informed decisions. Those with more education sometimes had better access to resources and more confidence advocating for themselves in healthcare settings. Additionally, the research showed that social support from family and community was crucial—participants with supportive family members were more likely to attempt healthy behaviors, even when facing economic barriers.
This research builds on existing knowledge that people with HIV have higher rates of heart disease than the general population, even when their HIV is well-controlled with medication. Previous studies have shown that HIV itself causes inflammation in the body that increases heart disease risk. However, this study goes deeper by examining the social and environmental factors that make prevention difficult. It aligns with broader public health research showing that poverty, neighborhood safety, and social support are major determinants of health outcomes. The findings support the growing recognition that healthcare providers need to address ‘social determinants of health’—the real-world conditions where people live, work, and play—not just prescribe medications.
This study has important limitations to consider. With only 20 participants, the findings may not represent all people with HIV in the South or in other regions. The study was conducted in three specific clinics, so results may not apply to people receiving care elsewhere. The research is descriptive, meaning it identifies barriers but doesn’t test whether specific interventions would actually help. Additionally, the study doesn’t include people with HIV who don’t have heart disease, so we don’t know if these barriers are unique to this group or affect all people with HIV. Finally, the study was conducted in 2026, so it reflects current conditions but may not capture future changes in healthcare or social services.
The Bottom Line
According to Gram Research analysis, HIV clinics should implement several evidence-based changes: (1) Screen all patients for food insecurity and connect them with food assistance programs—strong evidence supports this approach; (2) Provide tailored physical activity counseling that accounts for neighborhood safety and available resources—moderate evidence; (3) Involve family members in health discussions and education—moderate evidence; (4) Integrate cardiovascular disease prevention into routine HIV care, not as an afterthought—strong evidence. These recommendations are most appropriate for healthcare providers and HIV clinics, though patients can advocate for these services.
This research is most relevant to people with HIV who also have heart disease risk factors, HIV healthcare providers, public health officials in the Southern United States, and policymakers focused on health equity. People with HIV in other regions may find some findings applicable, though local barriers may differ. Healthcare providers treating people with HIV should use these findings to improve their care models. This research is less directly relevant to people with HIV who don’t have heart disease risk factors, though prevention is always better than treatment.
Realistic changes take time. If an HIV clinic implements food assistance screening and referrals, patients might see improved nutrition within 2-3 months. Physical activity changes might take 3-6 months to establish as a habit. Improvements in blood pressure or blood sugar levels typically take 3-6 months of consistent healthy behaviors. Long-term cardiovascular benefits (reduced heart attack or stroke risk) take years to develop. Patients should expect gradual progress rather than quick fixes.
Frequently Asked Questions
Why do people with HIV have higher rates of heart disease even when their HIV is controlled?
HIV itself causes chronic inflammation in the body that damages blood vessels and increases heart disease risk, even with effective antiretroviral therapy. Additionally, people with HIV often face social and economic barriers—like food insecurity and unsafe neighborhoods—that make it harder to prevent heart disease through healthy behaviors.
What can HIV clinics do to help patients prevent heart disease?
According to a 2026 study of 20 people with HIV, clinics should screen for food insecurity, provide exercise counseling tailored to neighborhood safety, involve family members in health education, and integrate cardiovascular prevention into routine HIV care rather than treating it separately.
How does neighborhood safety affect heart disease prevention for people with HIV?
People living in unsafe neighborhoods with poor street lighting, high crime, or lack of sidewalks and parks struggle to exercise regularly. A 20-person study found that unsafe environments were a major barrier to physical activity, making it difficult for people with HIV to prevent heart disease through exercise.
Can family members influence whether someone with HIV prevents heart disease?
Yes. Research shows that family members who model unhealthy behaviors—like eating fried foods or not exercising—make it harder for people with HIV to make different choices. Involving supportive family members in health discussions and education can improve prevention efforts.
How long does it take to see health improvements from better diet and exercise?
Blood pressure and blood sugar improvements typically appear within 3-6 months of consistent healthy behaviors. Long-term cardiovascular benefits like reduced heart attack risk take years to develop. Expect gradual progress rather than quick results.
Want to Apply This Research?
- Track weekly healthy food purchases and meals prepared at home. Set a specific goal like ‘Buy fresh vegetables 2x per week’ or ‘Prepare 3 home-cooked meals this week.’ Log actual purchases and meals completed to build awareness of progress and identify barriers.
- Use the app to find safe walking routes in your neighborhood or locate free community exercise programs. Set a weekly goal for physical activity that’s realistic for your environment—for example, ‘Walk in the park 2 times this week’ or ‘Join the community center exercise class.’ Share your goals with a family member or friend for accountability.
- Create a monthly check-in routine where you review your progress on healthy eating and physical activity. Track barriers you encountered (like expensive food or unsafe weather) and brainstorm solutions. Share this information with your HIV care team at appointments so they can help you problem-solve. Monitor blood pressure or blood sugar readings if you have a home device, and look for trends over 3-month periods rather than day-to-day fluctuations.
This research describes barriers to cardiovascular disease prevention among people with HIV but does not provide medical advice. If you have HIV and are concerned about heart disease risk, speak with your healthcare provider about screening, prevention strategies, and treatment options tailored to your individual situation. The findings from this 20-person qualitative study should inform clinical practice and future research but should not replace personalized medical care. Always consult your HIV care team before making significant changes to diet, exercise, or medications.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.
