About 1.2 million people in the United States now live with HIV or AIDS and more than 6,800 are in Minnesota.
Many of them also are poor, which makes it difficult to maintain healthy diets necessary for fighting the disease.
But for HIV patients like Gary Van Den Heuvel of Minneapolis the challenge of eating enough nutritious food to live with the virus is made easier by the meals delivered to his apartment each week.
The delivery comes from Open Arms of Minnesota, which provides free meals for about 800 people each week.
Van Den Heuvel, 63, was diagnosed with HIV in 1996. In recent months, he has suffered from nausea and has had trouble maintaining his weight. At 6'2", he weighs only 152 pounds.
"I have lost about 50 pounds from what I used to be," he told the Open Arms dietician while unpacking food. "I refer to myself as a bag of bones."
Eating well has always been important to Van Den Heuvel, who calls himself a health junkie. Since he contracted HIV, it's even more important for him to make sure he has the proper nutrition, but doing so is increasingly difficult because he lives on Social Security disability payments.
Van Den Heuvel, a former data analyst in the health care industry, was doing well financially before his diagnosis. He earned a good living and had a three-bedroom house with a landscaped yard. But that changed when he had to stop working.
Now he can't afford the foods he knows he should eat.
"I could afford junk food, but I wouldn't eat it," he said. "But nutritious food, like the vegetables and fruit, and good quality entrees, I would never be able to do that. I just would not."
That's where Open Arms steps in. For 25 years, since the early days of the AIDS outbreak in the United States, it has delivered food to HIV and AIDS patients. Back then, there weren't many ways to fight the disease, executive director Kevin Winge said.
"At that point, as people know, there were very few medications — certainly not medications that had any possibility of extending someone's life," Winge said. "So really what we had was food."
Patients needed food to fight AIDS wasting — the loss of body weight that was one of the main problems in the early days.
"The idea was really simple — let's get as nutritious and high calorie, high protein meals as we can," Winge said. "The desserts were huge and amazing in those early years. So let's get those to people with HIV/AIDS."
Nutrition was one of the few tools doctors had to help people prolong their lives. Patients who ate regularly and maintained their weight were better prepared to fight the inevitable infections.
"In those early years the majority of our clients died, so we knew that it wasn't going to keep them alive, but it might buy them more time, and more quality time," Winge said.
Since the development of new drugs in the 1990s people with HIV are living longer and Winge no longer sees nearly as much wasting. What's surprising, he said, is that some clients need to lose weight.
Eating well is still an important part of managing the virus. Patients with HIV are less able to handle periods of poor nutrition and often need to take their medications with food.
But using nutrition to manage the disease has become more complicated. There's no longer a one-size-fits-all meal.
Nutrition was one of the few tools doctors had to help keep people prolong their lives. Patients who ate regularly and maintained their weight were better prepared to fight the inevitable infections.
For Open Arms, supplying healthy meals to people with HIV is more difficult in part because most clients have other problems, such as high cholesterol and diabetes.
"Of course that has direct ramifications for the kinds of nutrition and meals we're providing," Winge said. "Now you're trying to take into account disease A, HIV/AIDS, but then you have this contributing factor of diabetes, or obesity, or high cholesterol. And it becomes very complicated."
Open Arms now offers eight different meal options, with a focus on fresh produce and locally-grown foods. Clients can also call for special food if they have mouth sores, nausea, or other concerns.
None of this comes as a surprise to Keith Henry, a pioneering HIV physician who now works at Hennepin County Medical Center in Minneapolis. Henry, who in 1985 started the first HIV clinic in Minnesota, has been around for much of the good news of the past decades, including new research and treatments. But he sees a problematic shift.
"The bad news is that HIV has become increasingly concentrated in poor communities," Henry said. "In fact, poverty has been shown to be a risk factor for HIV."
That means more people with HIV are having trouble affording food — especially healthy food. Even if Dr. Henry doesn't mention nutrition in clinic, his patients do.
"I have to almost restrain myself sometimes," he said. "When patients bring it up, I sometimes practically empty my wallet... when they tell me they have nothing to eat.
He said the situation is only getting worse with the economic downturn.