Date of Award

January 2014

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Debbie Humphries

Second Advisor

Louise C. Ivers

Subject Area(s)

Public health, Nutrition


There is consensus that food assistance is important for people with HIV, but no agreement on the optimal composition, duration, or delivery mechanism of this food assistance. Ready-to-use supplementary food (RUSF) is increasingly used as a component of food rations, but its acceptability as a supplementary food and its intra-household distribution have not been extensively evaluated in adults. This qualitative study evaluated the acceptability and use of RUSF compared to corn-soy blend as a targeted food ration in a comprehensive HIV treatment program in rural Haiti. Thirteen focus groups were conducted with 84 participants, 42 randomly selected from the RUSF arm of the study and 42 from the corn-soy blend arm. Focus groups were conducted using a guide with pre-designated core topics and open-ended questions. Data were recorded, translated, and synthesized into major themes. Four major themes emerged across ration types: ration taste, storage and distribution of rations within the household, sharing with neighbors, and selling of rations. For recipients of both RUSF and corn-soy blend: all participants shared rations with household members, especially children; most participants shared rations with neighbors; and few participants reported selling or exchanging food rations. Most participants found the corn-soy blend unacceptable and almost all participants added it to the communal household food supply. RUSF was widely considered to be delicious and was frequently separated from the household food supply--participants reported reserving a portion of the ration for their own consumption. In conclusion, RUSF was highly acceptable and was more often reserved for use by the individual with HIV in the household compared to corn-soy blend. Further examination of the perception and intra-household use of food rations is critical to improving the efficacy of food assistance for patients with HIV who live in food-insecure settings.


This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.