Diet, Environment, and Choices of positive living (DECIDE study): Evaluating personal and external food environment influences on diets among PLHIV and families in Dar es Salaam, Tanzania




 People living with HIV (PLHIV) face high food insecurity and double disease burden because food insecurity leads to lower adherence to treatment and poor health outcomes, while long-term treatment puts them at a higher risk of obesity and dyslipidemia. Caregiving and social structures of food culture further marginalize women in these contexts. New research shows that there are strong gender dimensions to dietary intake, adequacy, and survival rates among PLHIV. However, a gap remains in documenting the various domains in which these differences emerge, including capacity to procure food, bargaining power, social norms, and appetite since diagnosis. Further, little is known about how an HIV diagnosis affects the dietary patterns of uninfected family members. In this “Diet, Environment, and Choices of positive living” – DECIDE study, we will use gender lens to explore and characterize the drivers of food choice, food environment, and dietary adequacy among PLHIV and their families in Dar es Salaam, Tanzania. Our multiple-method approach and study findings will provide a robust understanding of the underlying motivations behind dietary choices and patterns among PLHIV and their families. Such data will be useful in shaping nutritional guidelines and interventions to disrupt the impact of the double disease burden.



Lead Institution

Purdue University

Collaborating Institutions


Africa Academy for Public Health; University of Illinois, Chicago; Harvard T.H. Chan School of Public Health



Principal Investigator(s)


> Ramya Ambikapathi, PhD, MHS, Purdue University, Post-doctoral research fellow in the Department of Global Health and Population at Harvard T.H. Chan School of Public Health and Department of Nutrition Science.



> Wafaie Fawzi, MBBS DrPH, Professor and Chair of Department of Global Health and Population, Harvard T.H. Chan School of Public Health

> Japhet Killewo, MBchB, MSc, PhD, Professor of Epidemiology at Muhimbili University of Health and Allied Sciences

> Crystal L. Patil, PhD, Associate Professor and Department Head, Department of Women, Children and Family Health Science, University of Illinois at Chicago

> Mary Mwanyika Sando, MD, MPH, Chief Executive Officer of Africa Academy for Public Health

> Aloisia Shemdoe, MSc, MA, BA, Social Scientist at Africa Academy for Public Health Tanzania.   

> Nilupa Gunaratna, MSc, PhD, Assistant Professor in the Department of Nutrition Science, Purdue University