Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS

Abstract

Food insecurity, which affects >1 billion people worldwide, is inextricably linked to the HIV epidemic. We present a conceptual framework of the multiple pathways through which food insecurity and HIV/AIDS may be linked at the community, household, and individual levels. Whereas the mechanisms through which HIV/AIDS can cause food insecurity have been fairly well elucidated, the ways in which food insecurity can lead to HIV are less well understood. We argue that there are nutritional, mental health, and behavioral pathways through which food insecurity leads to HIV acquisition and disease progression. Specifically, food insecurity can lead to macronutrient and micronutrient deficiencies, which can affect both vertical and horizontal transmission of HIV, and can also contribute to immunologic decline and increased morbidity and mortality among those already infected. Food insecurity can have mental health consequences, such as depression and increased drug abuse, which, in turn, contribute to HIV transmission risk and incomplete HIV viral load suppression, increased probability of AIDS-defining illness, and AIDS-related mortality among HIV-infected individuals. As a result of the inability to procure food in socially or personally acceptable ways, food insecurity also contributes to risky sexual practices and enhanced HIV transmission, as well as to antiretroviral therapy nonadherence, treatment interruptions, and missed clinic visits, which are strong determinants of worse HIV health outcomes. More research on the relative importance of each of these pathways is warranted because effective interventions to reduce food insecurity and HIV depend on a rigorous understanding of these multifaceted relationships.

Food Insecurity Is Associated with Greater Acute Care Utilization among HIV-Infected Homeless and Marginally Housed Individuals in San Francisco

“…Health-care utilization in the previous 3 months was measured by participant self-report and included the following outcomes: (1) any hospitalizations, (2) any ED visits, and (3) any outpatient or non-ED ambulatory visits (defined as any visit with a nurse, doctor, or other health-care provider for a physical health problem or preventative health care). We selected covariates for the study based on prior literature and theory, 35,[47][48][49][50] and included age (continuous), sex (male/female), race/ethnicity (African American versus Latino versus other), income (≥ versus < sample median), education (≥ versus < high school diploma), health insurance status (insured/uninsured), recent homelessness (sleeping on the street or shelter in past 3 months), illicit drug use (including cocaine, heroin, and methamphetamine) over the past 3 months (yes versus no), nadir CD4 count (continuous -100 cells/μl), and months on ART at baseline of analysis (continuous). We defined risky drinking as greater than an average of 14 drinks/week for men and 7 drinks/week for women in accordance with definitions by the National Institute of Alcohol Abuse and Alcoholism.…”

Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health

“…In diabetes, food insecurity is associated with increased risk of type 2 diabetes mellitus (T2DM) [4], poorer diabetes self-management [16,17], poorer glycemic (i.e., blood sugar) control [4], and increased hypoglycemic events [18]. Our previously published conceptual framework posits that food insecurity negatively impacts health through nutritional (e.g., weight, diet quality), mental health (e.g., depression, stress), and behavioral pathways (e.g., medication adherence and disease self-management) [19,20]. Intervention research is needed to understand not only whether medically appropriate food assistance may improve health but also to test whether food insecurity may be causally related to negative health outcomes.…”

“…There is a critical need for effective programs to improve the health of food-insecure populations with chronic illness or risk factors for chronic illness [19,20]. Sixty percent of food-insecure US households have participated in at least one federal food and nutrition assistance program, the largest being the Supplemental Nutrition Assistance Program (SNAP, called Cal-Fresh in California) [21].…”

“…We hypothesized that the intervention would improve nutrition, mental health, and health behaviors [19,20].…”

Reliability and validity of an individually focused food insecurity access scale for assessing inadequate access to food among pregnant Ugandan women of mixed HIV status

“…Women's responsibilities in managing family feeding (7) , gender bias in the experience of FI (8) and unequal control over household resources make them particularly vulnerable to FI and its consequences (3) . Data from the USA indicate that, when faced with FI, women suffer a range of negative nutritional (9) and psychosocial consequences (10,11) .…”