Table 3.

Supportive quotes of subdimensions of the Family Dynamics Framework (FDF).

1. RESOURCES
Social capital
1.1a “My children after seeing the state I was in and after getting ARVs [ART], … They got encouraged and as a result they buy me passion fruits and sugar.” (Hardon et al., 2007)
1.1b “… previously, they [PLHIV's parents] kept the food to themselves, but since they learned about my HIV, they reserved or shared the tasty food with me by bringing it to my house.” (Salter et al., 2010)
1.1c “… a treatment partner describes how ‘having friends who have shops’ provides access to credit that enables her to accommodate the food preferences of the patient she helps, who is not doing well: ‘The patient is seriously sick now. … we are borrowing rice from people with shops. They trust us and they lend, paying is a problem. I live with good neighbors who have shops.’” (Ware et al., 2009)
Resource allocation
1.2a “We know my mother [who is affected by HIV] needs to eat because she is sick so sometimes when she gets money from her ‘genge’ she can go and buy food for herself when we also have something to eat. We know she is sick so we cannot force her always to bring money for us.” (Mangesho, 2011)
1.2b “It was described as especially difficult not to share [food supplements] with children. A participant told her husband not to eat RUSF, but she said that telling a child would have been impossible: … If it were little children, I would be forced to give.” (Olsen et al., 2013a)
Household wealth
1.3 “‘ … In this community we have tended to think that the western foods represent being advanced. So when I get money for groceries, I tend to buy the refined foods partly because they characterise our consumption patterns although they are not healthy’ (IDI, male, 38 years). However, the respondents indicated that they relied mostly on wild fruits, as they could not afford to buy the exotic fruits sold in the supermarkets. All the participants indicated that during tough economic times they relied mostly on wild vegetables they could gather from the field such as mushroom and wild plants. They felt that the wild vegetables were rich in proteins and highly nutritious.” (Moyo et al., 2017)
Time use
1.4 “Wealthier families could hire labour to replace the caregiver's time, but for most families, AIDS meant the loss of two workers, not one … [as an HIV caregiver explained]. For almost a month, I did not go to the garden. I stayed at home taking care of him, cooking and washing.” (Kaler et al., 2010)

2. CHARACTERISTICS
Composition
Generations
2.1a “[I] went back to my hometown to live with my parents when my husband died. … they look after my son. My mum cooks for me. They also give me many supports. … [and] money to buy medicines.” (Klunklin and Greenwood, 2005)
2.1b “A 57-year-old woman, who was responsible for feeding three grandchildren as well as her two youngest children, explained: ‘I eat less food so my children can eat, because their lives are ahead of them, and mine is about to end, and they feel the privation of hunger more than I do. So I eat less.’” (Weiser et al., 2010)
Gender
2.2 “Few husbands regularly helped women in the tasks of cooking, fetching water, washing clothes and utensils; more men regularly helped with taking family members to the doctor, purchasing groceries and providing childcare. There were, however, some men who contributed to the household.” (Davis and Kostick, 2018)
Aging
2.3a “Many of the participants … had lost supportive children and grandchildren or were worried about losing their children as a result of the HIV epidemic. A few were reliant on care and support provided by grandchildren for whom they were responsible, resulting in different levels of mutual responsibility, support and care. Some of the older people received support from their own children, now adults, and some were reliant upon neighbors to help them get food and water …” (Wright et al., 2012)
2.3b “… the elderly modified their lifestyle and their behavior after the HIV/AIDS diagnosis. This triggered changes in the social and health dimensions, causing isolation and reduction of contact with people. … Interruptions of activities, previously routine, may be justified by the embarrassment generated by the diagnosis of an infectious disease, [and] fear that its condition is discovered …” (Araujo et al., 2018)
Household Health Status
Co-morbidities
2.4 “The patients, the shared, may have not only multiple health concerns but also socioeconomic barriers that can impede the patient's ability to engage in self management behaviors. One provider shared about unhealthy eating habits among her patients, ‘[My patients] are eating what is available, that's why [they] get diabetes [and] high blood pressure, because most of … [their eating habits] are not changed’ (Provider, Botswana). While the providers and healthcare team members shared the actions they took to encourage diet and exercise in their interactions with patients, they also recognized that they must also consider the competing needs their patients experienced … One provider shared: … ‘Some patients will tell you that they can't adhere because they don't have anything, no food, nothing …. A home probably trumps (worrying about) the cholesterol.’” (Webel et al., 2017)
Chronic diseases
2.5a “Many participants reported that receiving the incentives reduced stress, worry, and depression, and fostered a sense of peace because they were able to meet basic needs. These results suggest that mental health may have improved temporarily among transfer recipients, although this topic was not included in the interview guide.” (Czaicki et al., 2017)
2.5b “Participants in our study perceived that mental health was altered through several key mechanisms, including: improved food security and ability to provide for family, more productive daily routines (thereby reducing time for and attention to persistent fears), enhanced social standing that accompanied being more active community members.” (Hatcher et al., 2020)
2.5c “… I have to cook soft foods like banana and soup, which she [PLHIV] can eat. I also have to cook for other family members. My parents are old. They can't do anything; they depend on me. I pay attention to the patient because she may need my help… At the end of the day, I find myself exhausted; the day ends just like that.” (Pallangyo and Mayers, 2009)
Household size
2.6 “My health has changed but my diet has not. There are 14 people in my house who need to eat. I appreciate the food I receive, but it's not enough.” (Kalofonos, 2010)

3. ACTION ORIENTATION
Support
3.1a “Since the nausea and fatigue associated with the medication tended to make patients lose their appetite, family members countered this by cooking for them or making their favorite dishes.” (Paz-Soldán et al., 2013)
3.1b “My brother's wife discriminates against me all the times. She says I must go to the person who gave me HIV. At times she cooks food late beyond the time I am supposed to be taking my medication. The living conditions are very difficult for me now, as l don't have a job to enable me to be independent. … [she] has the final say on what she buys. She usually spends the money on herself and sometimes she doesn't buy enough food for the whole month.” (Moyo et al., 2017)
3.1c “We don't have fear of HIV. We will not get [HIV] by touching him; that's why we help. When we go in field area, if such person is there, we sit beside him, eat in the same plate”. But the practices of an ART naïve widow (CS13) were as follows: ‘Now if I ask her [daughter] for a glass of water, then I don't let her drink from the same glass. I don't let her touch it at all. The water that I've drunk, I do not allow anybody to have it. Now I do not share the food from my plate with anybody else at home.’” (Kohli et al., 2012)
3.1d “A secondary driver of food insecurity were disruptions in social networks (family, friends, neighbors) due to HIV-related stigma, which distanced people from important social sources of food support.” (Derose et al., 2017)
Value negotiations
Competing basic needs
3.2a “Children need to eat, the house rent needs to be paid; children fall sick like any other children in the world and therefore need medical treatment. If the business is small, the life becomes very difficult. If you have rented the house, the owner doesn't care that you are sick. If you don't have money for the house, the owner can just take your properties out because really, she/he needs money.” (Pallangyo and Mayers, 2009)
3.2b “… I have been having some financial challenges ever since I lost my job, which she does not seem to understand. Town life is very difficult. We buy everything; food, fees, rent and others … I know its my responsibility to provide for her but we only could afford one small meal a day. She was unhappy with me when it became difficult for me to provide for her special meals, shelter, transport and other needs when I have no job at all so she left to stay with another relative. (study participant's paternal aunt).” (Atukunda et al., 2017)
3.2c “Under such circumstances, there were times when the carer was forced to prioritise immediate household requirements over those of caring, particularly if without assets, the household was unable to generate cash to pay agricultural labourers or to purchase food. The difficulties facing the household therefore have significant repercussions for the well-being of the patient since the carer has far less time and resources to spend ensuring that even the basic needs of the patient are met.” (Thomas, 2006)
Family desirability
3.3 “During Ramadan, I only take the evening [ART] dose. It is impossible to take the morning dose as we eat during the nighttime.” (Bezabhe et al., 2014)

4. HEALTH CONTEXT
Impact on livelihoods
4.1a “The loss of income from patients who were the main breadwinners resulted in severe financial constraints. Household economic problems often began when patients began to suffer from frequent HIV-related illnesses, especially when caregivers were also unable to work because of caregiving responsibilities, thus further reducing financial security.” (Pallangyo and Mayers, 2009)
4.1b “When a husband or adult child falls ill, the older woman often takes over the physical responsibilities and day-to-day tasks of caregiving. … When caregiving takes precedence, other income-generating or resource-gathering tasks may suffer. Some of the respondents talked about such disadvantages. Pearl, a 74-year-old widow, said: The disadvantage is this, you always work hard and you don't get a chance to do your own things. For instance, my husband fell sick during the summer season. I was supposed to go to the field and plough mealies and vegetables but I didn't because I was busy taking care of my husband, so my heart was painful when I saw other women harvesting food ploughed with their own hands.” (Ogunmefun and Schatz, 2009)
4.1c “Days revolve around being able to find adequate resources for their family (food, shelter), and access to school for children. Only one woman had a steady job, which was keeping house 3 days a week for another woman who lived outside Kibera. Others earn money by doing casual work such as washing, braiding hair, making and selling soap, custom crocheting, and catering at community functions when invited.” (VanTyler and Sheilds, 2015)
4.1d “We try working for piece work [ganyu] for food or money; however, with the medications [ART] we are on, it is even difficult for us to work for long hours.” (Gombachika et al., 2014)
4.1e “Availability of time to visit the clinic was another major factor that reportedly delayed ART initiation. For many, work commitments and the fear of losing their jobs as a result of the many days required at the clinic in order to start treatment delayed linkage to care or resulted in patients not completing the ART initiation process: ‘ … we have these jobs that we are doing and it's not that easy to stay or ask for days off every week, because they would have a concern about abusing sick leave.’” (Gombachika et al., 2014)
Healthcare
4.2 “Others think that ART is free. They don't see costs associated with the treatment. In fact, we found out that ART was rather expensive. We have to pay for laboratory investigations except CD4 count. We have to pay for other medicines. We pay our transportation fees. Some of us have to stay a night or two. Accommodation is expensive. In general, the town is expensive. And some of us are self- employed. We leave our work for two to three days. These were major reasons for some patients to stop treatment.” (Balcha et al., 2011)
Community support
4.3 “She lived there for two years, then returned to Addis Ababa and eked out a living selling injera; most of her patrons were friends. She continued to get weaker, and a friend who knew her status convinced her to go to ALERT, where physicians started her on ART. Several years later, she met an HIV-positive man at church; they are now married, and she describes her husband as a supportive partner. Both of them are very active in the community and especially in the community coffee ceremony programme. The traditional coffee ceremony is a classic feature of traditional Ethiopian home and community life. The coffee ceremony is a gathering given by village dwellers. We call both those who are HIV positive and negative people and teach them about HIV. We usually get some people who ask for forgiveness for their wrong discriminatory actions they committed, after they understand about problem. I believe all these things happen due to low levels of understanding. That is what the coffee ceremony has brought for us. The community gathers and discusses it openly. The other benefit of coffee ceremony is it provides ways for us [PLHIV] to help each other. For example, if a person is in short of money even to come to ALERT, they will be given some money from the contributions we collect from the crowd at the coffee ceremony. When someone is found ill, all of us will go and visit him/her turn by turn. We also have a saving scheme and we save 10 birr per month in addition to the contribution to coffee ceremony group, which is 2 birr per month. Then we also give a credit service to the members to get a small loan, work with it and pay back with small interest.” (Hussen et al., 2014)
Acceptance
3.4b “Disclosure could be associated with improved access to HIV-care services and therefore earlier presentation: ‘I suffered for two years. Time came when I lost appetite and could not eat food; I weighed 25 kg … My daughter urged me to take an HIV test at a nearby clinic. I disclosed my status to my daughter, but she could not afford my care at [that] clinic. She then brought me here at the Uganda Cares clinic.’” (Kuteesa et al., 2012)
4.4b “The reactions of my family members has not changed since they know my HIV status, in fact, my husband still uses the same plates, cutleries and every other things with me, even when I try to stop him, he is not bothered at all and he is HIV-negative.” (Aransiola et al., 2014)
4.4c “The Zambian practice of shared bowls, utensils and the use of hands to eat lead some participants to express distress at changes in eating arrangements, such as ‘[They] don't want to eat together thinking they will be infected, sometimes they want to use separate kitchen utensils. When you are eating, then a child comes to eat from your plate; he is told not to eat with you.’” (Jones et al., 2009)
4.4d “… [stigmatizing behaviors] included isolation of eating, eating utensils (e.g., AIDS cup), and dishwashing sets, as well as restriction from some food items, (e.g. beef, catfish, egg, preserved foods) or supplementing the diet with special foods or drinks (e.g., milk, nutritional tonic, boiled water). The duration and the degree of Adherent and Nonadherent behaviors were determined partly by HIV status and its stigma.” (Ngamvithayapong-Yanai et al., 2005)
Nutritional awareness
4.5a “Primary family caregivers encouraged healthy nutrition and deemphasized taboo food because they believed that healthy food would increase immune function for the PLWH. A 44-year-old mother and caregiver said the following: ‘I do not allow him to eat pickled food, stingray fish, anchovy fish, or raw food, since he got skin itching and rash after having these foods. No alcohol, since alcohol will react with antivirus drug …. I encouraged him to have organic vegetable and fruit.’” (Wacharasin and Homchampa, 2008)
4.5b “Sometimes she [daughter who is affected by HIV] is in a bad condition and she chooses food that her heart needs. But myself I am poor and I cannot give her what she wants, and sometimes she spends the whole day without eating because I cannot afford what she wants to eat.” (Thomas, 2006)
4.5c “In general, families … are well aware of the links between HIV/AIDS and nutrition, but they are unable to prepare special meals because of the competing demands on their limited financial resources and time. … some special meals had been provided to the sick in the past, when resources were more abundant, but now sick people were eating what was prepared for the whole household.” (Laker and Ssekiboobo, 2003)