Although food security has largely been a rural issue, it is increasingly an urban concern, particularly in slums and informal settlements of southern Africa. In Malawi, high urbanization rates are leading to new configurations of the urban landscape, characterized by the growth of slums. Slums highlight the increasing prominence of poverty within cities, exhibited by deplorable living conditions. Much of this poverty stems from absence of economic growth relative to the rate of urban growth. Given that cities are cash dependent, slum residents often cut back on food expenditures, which are viewed as variable compared to more fixed costs such as rent, fuel, and education. Food security is further complicated by the HIV/AIDS epidemic, which largely affects the most economically active segments of the population (15–45 years), resulting in the erosion of social and human capital, and removal of social safety nets. Good nutrition, imperative for people infected with HIV/AIDS, slows progression of the disease, makes medication more effective, and maintains immune strength to fight opportunistic infections. The burdens created at the intersection of HIV/AIDS and food security disproportionately affect women because they are physiologically more susceptible to infection and furthermore, they are the primary care givers, producers and acquirers of food within households. The status and resources available to women are therefore central to addressing the problems outlined above. Drawing on a pragmatist perspective emphasizing context, this study holistically explores the causal dynamics and linkages between poverty, food insecurity, HIV/AIDS and gender in Kauma and Mgona, two slums in Lilongwe, Malawi. While food insecurity was high in both study sites, geography accounted for the differences, affording Kauma residents a wider range of livelihood activities. Contrary to the literature, migration to the city for many women limited their ability to contribute to their household, financially or by acquiring food, and as such decreased self-determination. Gender dynamics within households and the resources available to women in the urban environment, determined women’s contributions to household food and nutritional status. Only by holistically studying food insecurity and the interrelated complexities of poverty, HIV/AIDS and gender, can we begin to find comprehensive solutions.