Food insecurity: A key structural barrier to HIV/AIDS care

Sheri Weiser, University of California, San Francisco
Social and Behavioral Sciences
Thematic Priority Area: Contextual, Cultural, and Structural Issues in HIV Prevention and Care
Innovative, Developmental, Exploratory Award (IDEA)

Food insecurity (defined as having uncertain or limited availability of nutritionally adequate or safe food or the inability to procure food in socially acceptable ways) affects 40 million households in the U.S, and the prevalence has been rising since 1999. There is growing recognition that food insecurity may negatively effect HIV disease progression and the effectiveness of antiretroviral treatment (ART), but there is little data to support this. Among HIV-infected urban poor individuals, competing demands between resources spent on food versus medical care may also lead to missed clinic appointments and decreased use of ART. Similarly, while data from sub-Saharan Africa shows that food insecurity is an important cause of risky sexual practices, there are no data on this issue from domestic populations. Without clear data documenting how food insecurity impacts upon HIV outcomes, access to care, and HIV transmission risk behaviors, it is unclear to what extent resources dedicated to HIV management should also be invested in ensuring safe access to food. Food supplementation is a potentially important adjunct to HIV care. To address these gaps, we propose a 1-year study in San Francisco with the following specific aims: 1)Determine the impact of food insecurity on adherence to ART medication regimens and HIV treatment outcomes among participants enrolled in the Research on Access to Care in the Homeless (REACH) cohort. 2) Determine the impact of food insecurity on access to health care and initiation of ART among REACH participants; and 3) Determine the association between food insecurity and high-risk sexual behaviors among REACH participants and whether these associations differ by gender.

We will leverage the resources of the REACH cohort, an ongoing observational cohort study of over 300 HIV-infected individuals in San Francisco, and will follow participants every 3 months for 1 year. The key predictor will be food insecurity, measured by the Household Food Insecurity Access Scale. Key outcomes include antiretroviral adherence, HIV viral load suppression, use of ART, health care follow-up, and unprotected sex. For our analysis, we will use repeated measures analysis, which will enable us to determine how food insecurity is impacting health behaviors and health outcomes over time. In order to tease apart the effects of food insecurity from other related variables, we will control for the effects of other socioeconomic factors, nutritional status, drug use, mental illness, social support, and health status.

This study is innovative in that it will provide the first quantitative and longitudinal assessment of the effects of food insecurity on HIV health behaviors and health outcomes in the U.S, and will be the first to explore the social and behavioral mechanisms through which food insecurity may negatively impact care. This proposal will provide the preliminary data for the development of an intervention study in San Francisco of the role of targeted food assistance on HIV health outcomes, use of health services, and transmission risk, which will be proposed as an NIH-funded grant at the end of the study period. The results of this research may help argue for better integration of food aid services and HIV care services among people living with HIV/AIDS in San Francisco and elsewhere.