In South L.A., 'food deserts' impact health of HIV/AIDS patients

For people living with HIV or AIDS, nutrition is a key component of any treatment plan. With a weakened immune system, it is vital that they maintain optimum health by way of exercise and following the basics set forth in widely-accepted dietary guidelines.

But living in neighborhoods where healthy food options are few and far between, with an outsize presence of fast-food outlets, can make it difficult to eat healthy.

In a 2010 report called "Food Desert to Food Oasis: Promoting Grocery Store Development in South Los Angeles," Community Health Councils, a nonprofit policy and educational organization, the authors found that residents living in the area have fewer opportunities to make healthy food choices than people in other parts of the county.

"As in many inner-city communities where lower-income and racial or ethnic minority individuals reside, South L.A. has suffered from a dearth of private investment and the inequitable distribution of public resources," the report said. "Home to over 1.3 million people, the area's 60 full-service grocery stores equate to one for every 22,156 residents in contrast to the 57 stores in West L.A. that equate to one for every 11,150 residents. Limited access to supermarkets with affordable, nutritious food creates a 'food desert' and significant barriers to healthful eating that are too high for many individuals and families to overcome."

In 2009, community organizations and retail developers gathered to discuss barriers to attracting grocery and health food stores to the region.

Matthew Dodson, director of government relations for the California Grocers Association, told The Wave then that conversations on the matter have been held over the years. He explained that the community, grocery stores, local governments and redevelopment agencies were trying to address the matter independently instead of collaboratively. Dodson also detailed several larger barriers, including land assembly, time-consuming and money-draining city permitting processes and the belief of grocery operators that other areas, such as the westside, are more profitable.

Instead, communities in South Los Angeles are overrun by fast food chains, which has an affect on the health of those infected and uninfected with HIV and AIDS.

Darryl Hendrix, who has been HIV positive for 22 years, said that in the beginning he did not pay attention to the foods he consumed because doctors "told me I only had six months to live," he said.

At the onset of the disease, he dropped to 160 pounds. "I didn't do the right things or eat the right foods. I just thought I was going to die," he said. "As the years went by, I learned that I'm going to be around for my grandkids and my kids. I am able to have a life because I started eating right."

Since taking nutritional classes, Hendrix, who carries 210 pounds on a tall frame, has taken off 10 pounds.

"In the last five years I have changed my whole diet. I have one burger a month and pizza every now and then," he said, adding that he also does a lot of walking. "I have more energy than when I buy junk food."

Instead he eats more fruits and vegetables and purchases sugar-free chocolates and candy.

LaVera Anom, who has been HIV positive for nearly a decade, suffered from gestational diabetes and also deals with a thyroid problem that has led to weight gain. "My metabolism is slow as a snail," she said. "It kicks in when it wants to; most times it doesn't. So, I have to take medication for hypothyroidism. I am no longer a diabetic, but I am at a greater risk of developing diabetes."

She admits that she does not always eat the foods recommended by her nutritionist, though she puts in efforts to somehow incorporate fruits, dairy and vegetables in her daily diet along with exercise. But dealing with severe depression, she said, makes accomplishing those goals difficult.

“I have a treadmill in my room; it’s on my mind but it just hasn’t been put into practice very much. It’s right by my bed so I can roll out of bed and jump on it. But it just doesn’t happen as much as my mind tells me I should,” she said. “The medication coupled with the thyroid illness, gaining weight is a given and I really need to work on that. I have not found any support systems for that. Many people who take [HIV] medication start gaining weight.”

Her go-to foods are sweets and fried foods; however, when she is eating healthier she goes for yogurts, nuts, cottage cheese and baked foods. Anom steers clear of pork and shellfish for religious reasons.

Precious Jackson, who has been HIV positive for 14 years, said that there were times when she went on junk food binges. "I love fried chicken," she said, adding that her most recent binge lasted for about two months. "I ate whatever I wanted to. But when I went back to the doctor and she told me that my cholesterol had doubled. It scared me. I told myself then that I needed to get it together."

During those binges, Jackson noted that she was exhausted and her cholesterol spiked. Still, she maintains that her health today is on the right track despite caving into fried foods at least once a month.

“I am still able to live a normal life. I eat more healthier now. I am more healthier than I was before. I am also a diabetic so I have to be very conscious,” she said, adding that she incorporates Kale and spinach into her meals. “I eat more vegetables and lean meats as well as fruit, but I have to watch that because of my diabetes. I also drink a lot of water. I have backed off of the bread too.”

Combining nutrition and exercise and lowering her caloric intake, Jackson said her “health has improved, my T cells are now really high and my viral load is undetectable. T cells are a part of the immune system that help fight off infections. The less virus you have in your body, the better off your body is [when it comes to] fighting off the HIV virus and any other related illnesses.”

Despite structural and institutional hurdles, organizations like AIDS Project Los Angeles — which operates nine food banks specifically designed for AIDS or HIV patients living in poverty-ridden areas — are finding creative ways to improve nutrition for their clients.

"My mantra has always been that nutrition is a life-sustaining treatment for everybody, it does not matter if you have an illness or not," said APLA nutritionist Janelle L'Heureux who has worked in the field for more than a decade. "Food … allows for tissue growth, tissue repair, immune components. So, if someone becomes undernourished or malnourished, then they are going to become more susceptible to opportunistic infections that we are exposed to all of the time. It is important for everybody, but particularly when you have HIV … to eat well."

In the beginning of the AIDS epidemic, L'Heureux said nutritionists recommended diets high in protein and carbohydrates, because many AIDS patients simply wasted away.

"It was a different disease at that time," L'Heureux said. "Today we do not have that if you are in care or being treated."

Instead, more nutritionists are seeing obesity, high blood pressure, high cholesterol, diabetes and other illnesses due to poor eating habits and overconsumption. Fast foods and junk foods are high in calories and fewer of the nutrients and antioxidants needed to maintain a healthy immune system.

"They are moving to look more like the face of America," L'Heureux said, particularly those who live in areas inundated with fast food chains or those who are not accustomed to following a nutritional plan.

When it comes to choosing between the dollar menu at a fast-food outlet or spending significantly more on fruits, vegetables, grains and lean meats, people on a tight budgets — especially those who are not trained to eat healthy or have limited transportation — see the cheaper option as an acceptable bargain.

A problem, besides the type of fares actually being consumed, is the amount of food people have grown accustomed to eating. L'Heureux and other nutritionists now recommend that patients consume no more than what can fit on a small salad plate.

"I don't know why it took us so long to get to something so simple," she said of the conclusion that was drawn recently at a forum with other nutritionists involved in AIDS/HIV organizations.

But people also must plan for good nutrition, L’Heureux said. “When there is fast food on nearly every corner the pattern is to get the burger and the fries, not the salad with the apples and the walnuts. You are going to fail. You have to have a nutrition plan.”

So how can nutritionists get around food barriers?

One way is seen through Aid for AIDS Keep it Fresh food program, which encourages healthy eating habits and offers need-based vouchers for groceries from either Ralphs or Food 4 Less.

However, L'Heureux and her team are constantly trying to find creative approaches for those who insist on eating out.

Burger and fries, she said, are not the best choices, but people may ask for  wheat bread, or additional vegetables or even supplement the beef patty with turkey or a veggie burger. To cut costs as well as calories, they can cut the burger in half and save the other portion for a future meal.

APLA also has developed a program called Eating on a Budget, in which clients and nutritionists figure out ways to get the needed vitamins and minerals. One way clients do so is by shopping at deep discount stores that offer food items, L'Heureux said.

While some food studies contend that the quality of foods at 99 cent stores and other similar chain markets are not suitable because in order to offer such inexpensive prices they must get the tail end of the batches, which is often on it’s way to spoiling and therefore has less nutritional value, L’Heureux said that when it comes down to it they offer more nutrition than fatty foods found at fast food restaurants. The point is to offer healthier alternatives in an arena where money matters and resources are low.

By re-using left-overs, L'Heureux said clients can get the biggest bang for their buck by creating entirely different meals. Ground meat, for example, can be used in a variety of fares — including tacos, salads and spaghetti.

And if preparation is not a person's strong suit, L’Heureux, who matches up clients’ dietary plans with what they are getting from APLA’s food pantries, said he or she can be guided by way of food demonstrations.

"The pantry was initially conceived of as a supplemental source of food for clients," APLA Communications Director Gabriel McGowan said. “They would do whatever shopping they could on the budget they had. Then the purpose of coming to our pantry was to supplement that with some of the grains, dairy and other stuff that maybe they couldn't afford as part of their weekly shopping budget. What we are seeing more of now are clients” whose food comes almost exclusively from the pantry.

"South L.A. is probably the largest area of the county that we are focused on right now, just because it is so resource-poor, there are so few options for clients," he added. "Clients who are receiving treatment … have to have certain types of food. The side effects can be managed by diet."

According to L'Heureux and McGowan, often when their clients diet is maintained they begin to see their blood pressure and cholesterol normalize. "Their health outcomes are improved," McGowan said; while L'Heureux added that "we've even seen some taken off of insulin" and medications that were being distributed in order to manage such conditions as diabetes or high blood pressure.

This reporting was undertaken as part of The California Endowment Health Journalism Fellowships, a program of USC's Annenberg School for Communications & Journalism.