Food does not just provide energy and nutrients but is a part of how we live and interact with each other. Food insecurity erodes these needs and values, and it introduces ethical complexities for researchers and health services. If HIV is added to the scenario, then it becomes even more confusing. The linked randomised controlled trial by Ndekha and colleagues (doi:10.1136/bmj.b1867) compares the effect of two nutritional interventions on clinical outcomes, including weight gain and lean body mass, in adults with HIV who are receiving antiretroviral therapy.1

People with HIV have greater nutritional needs than those without.2 Evidence supports funding for programmes that provide nutritional support to adults and children with HIV, especially those who are malnourished or have opportunistic infections such as tuberculosis. Improved nutritional outcomes are reported in adults and children on antiretroviral therapy who receive additional energy and micronutrients.3 Such gains may represent the recovery of lean body mass in response …