Table 2.

Primary and secondary themes to address food insecurity in HIV care.

Primary Theme	Secondary Theme	Illustrative Quotes
Patient-level barriers	Embarrassment, shame, and judgement	"A lot of times, patients are ashamed that they are in this situation, and they don’t want to openly talk about it.” (31-year-old social service provider) "My patients have this shame and embarrassment about asking for a food pantry referral, which makes it hard for me to address [it].” (33-year-old social service provider) "[Patients] are not open and honest about not having food. They're embarrassed about it. They don’t want to come in here talking about having a hard time struggling to get food because they don’t want to be judged. I always tell them, I'm here for you, but I can’t help you if you don’t tell me.” (66-year-old social service provider)
	Health literacy	"They didn’t get infected with HIV because of food insecurity, so patients don’t understand the importance of how food security helps with HIV treatment and having a healthy immune system.” (33-year-old healthcare provider) "A lot of patients generally appear healthy and fit. That’s one thing that makes them put less weight into the importance of food security. Even if they don’t eat every day, it’s not showing in their physical appearance, so they think don’t need to prioritize that.” (31-year-old social service provider)
Provider-level barriers	Time	"Honestly, lack of time .... There's so much going on for these patients, that it’s hard to fathom adding one more thing to do. it’s hard to take all of the social elements, like food insecurity, into consideration.” (33-year-old healthcare provider) "The biggest barrier is time. Assuming the patient arrives on time, once they are checked in, the nurse has to do their updating, so the provider might get 15–20 min and has a list of medical things they need to address. The last thing that they are there to talk about is their food insecurity.” (39-year-old social service provider)
Provider-level facilitators	Patient-provider relationships	"One of the biggest things is coming from us as the providers is having a huge line of communication so that patients feel comfortable enough to tell us and ask us for the things that they need of, like food.” (49-year-old social service provider) "Having a relationship with them, knowing them and having met them before, that definitely sets the foundation where I can learn more about their background, their home life, and feel comfortable addressing their food situation. Similarly, if patients feel safe and comfortable coming to our clinic, they'll be more likely to like share more vulnerable or embarrassing topics like food insecurity.” (36-year-old healthcare provider)
Clinic-level barriers	Funding	"Not having the funding to be able to provide those immediate needs to address those food barriers definitely hinders. We have to fight hard to be able to even get the little funding we have.” (38- year-old social service provider) "With grant funded programs, things have to be done so specifically and the requirements are so much that it makes it a barrier for patients to engage in services.” (66-year-old social service provider) "We get funding to promote things for the patients, like food services, and they [funding agencies] make it difficult to get things. 'No, no, you don’t have the money for that.' Well, why not? Why can’t we get it to get to the patients? 'Well, that’s not really what it’s for.' Well, that’s what it should be for.” (54-year-old healthcare provider)
Clinic-level facilitators	Onsite resources	"Having our onsite food pantry certainly helps with what we need for addressing food insecurity among our patients.” (28-year-old social service provider) "I think the fact that there's a food bank makes a really big difference because there's instant access and supplies to address their barriers.” (32-year-old healthcare provider) "We can get patients set up with the food pantry to get them food and get some future appointments so they don’t have to stress like, 'will I have food next month?' Yes, you will. We're going to get you an appointment so you can get that food for next month. We definitely see how easily the weight just lifts off their shoulders knowing that they won’t have to worry about where their food is coming from that next month.” (23-year-old social service provider)
Community-level barriers	Community norms and intersecting stigmas	"We see it a lot with our folks who are HIV positive, that they still feel that stigma in the community. They're too afraid to kind of ask for help. They're afraid to come forward with their food insecurity needs because they don’t want people to find out about their diagnosis.” (28-year-old social service provider) "Some patients don’t like saying 'yes, I need help' because there is stigma in the community associated with using a food pantry.” (39-year-old social service provider) "There are a lot of compounding and stigmatizing factors that keep patients from receiving food services. A lot of my patients have a lot of nervousness about that. If their HIV status comes up, how are they going to be looked at and treated?” (28-year-old social service provider)
	Limited access to healthy food	"On the east side, there's really only one grocery store, and people within many square miles who don’t have a car or transit access have no access to healthy foods. That really hinders my ability to help.” (33-year-old social service provider) "It’s the lack of grocery stores. Public transportation is terrible. It’s a matter of if you don’t have a car and the nearest full-service grocery store is five or six miles away and the bus runs once an hour, and you have to catch two buses to get there. I can’t help if my patients don’t have physical access to food.” (31-year-old social service provider)