Barriers and facilitators of cardiovascular disease prevention among people with HIV in the Southern United States: a photo-elicitation study.

BACKGROUND

As progress toward the 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. Despite effective antiretroviral therapy, people with HIV remain at elevated risk for hypertension, diabetes, and cardiovascular disease, while HIV care models often prioritize viral suppression over integrated cardiovascular prevention.

OBJECTIVE

This study aimed to explore the social and structural determinants that shape cardiovascular preventive health behaviors among people with HIV in the Southern United States to inform the development of interventions that promote sustained health outcomes.

METHODS

We conducted a qualitative descriptive study with twenty people with HIV aged ≥ 35 years, each living with at least one cardiometabolic condition, recruited from three HIV clinics in the Southern United States. Photo-elicitation integrated with semi-structured interviews allowed participants to document and interpret their experiences related to diet, physical activity, lifestyle behaviors, and health monitoring.

RESULTS

Thematic analysis mapped findings to five determinant domains: economic stability, neighborhood and environment, social and community context, education, and healthcare access and quality. Participants (median age 57; predominantly African American/Black; most living with HIV for more than 10 years) identified three intersecting, modifiable barriers: the high cost of healthy food, unsafe or poorly designed environments limiting physical activity, and family or peer norms reinforcing unhealthy behaviors.

CONCLUSIONS

These findings highlight the need to embed food insecurity screening, context-tailored activity counseling, family engagement strategies, and structural supports within HIV care to advance equitable cardiovascular prevention for people with HIV.