Food insecurity and pediatric HIV: patient perspectives on clinical solutions.

Food insecurity is a prevalent social determinant of health for people living with HIV and is associated with suboptimal treatment outcomes. While clinic-based efforts to address food insecurity have increased over the past decade, few studies have explored the perspectives of paitents and caregivers managing chronic illnesses such as HIV. Caregiver insights are particularly critical in pediatric HIV care, where caregivers often play a central role in screening and referral processes. This study examined the experiences of adolescents and young adults living with HIV and caregivers of children with HIV, to inform screening and referral practices within a pediatric palliative care clinic in Atlanta, GA. We conducted audio-recorded, in-depth interviews (n = 14) and focus groupswith 10 patients and caregivers living with food insecurity. Thematic analysis, guided by our interview topics, revealed five key themes: (1) trust in providers, (2) coping by "making it work", (3) barriers to healthy eating, (4) challenges to medication adherence, and (5) recommendations for cross-sector resource connection. Our findings underscore the need for partnerships between clinics and community-based organizations, bolstered by structural and systems-level interventions and policies, to promote food security and well-being for pediatric patients in complex care settings.