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Background: Ready-to-use supplementary food (RUSF) is increasingly used as a component of food rations for adults with HIV. Methods: We undertook a qualitative study to evaluate the acceptability and use of peanut-based RUSF compared to corn--soy blend (CSB) among adults living with HIV in rural Haiti who had been enrolled in a prospective, randomized trial comparing the impact of those rations. A total of 13 focus groups were conducted with 84 participants--42 selected from the RUSF arm of the study, and 42 from the CSB arm--using a guide with pre-designated core topics and open-ended questions. Results: We found that RUSF was highly acceptable in terms of taste, preparation, and packaging. Both types of food ration were widely shared inside and outside households, especially with children. However, while CSB was without exception stored with the communal household food supply, RUSF was frequently separated from the household food supply and was more often reserved for consumption by individuals with HIV. Conclusions: RUSF was a highly acceptable food ration that, compared to CSB, was more often reserved for use by the individual with HIV. Qualitative examination of the perceptions, use, and sharing of food rations is critical to understanding and improving the efficacy of food assistance for food-insecure people living with HIV. [ABSTRACT FROM AUTHOR]