Food Insecurity and Sexual Risk in an HIV Endemic Community in Uganda

Abstract

Food insecurity has been linked to high-risk sexual behavior in sub-Saharan Africa, but there are limited data on these links among people living with HIV/AIDS, and on the mechanisms for how food insecurity predisposes individuals to risky sexual practices. We undertook a series of in-depth open-ended interviews with 41 individuals living with HIV/AIDS to understand the impact of food insecurity on sexual-risk behaviors. Participants were recruited from the Immune Suppression Clinic at the Mbarara University of Science and Technology in Mbarara, Uganda. Interviews were recorded, transcribed verbatim, translated, and coded following the strategy of grounded theory. Four major themes emerged from the interview data: the relationship between food insecurity and transactional sex for women; the impact of a husband’s death from HIV on worsening food insecurity among women and children; the impact of food insecurity on control over condom use, and the relationship between food insecurity and staying in violent/abusive relationships. Food insecurity led to increased sexual vulnerability among women. Women were often compelled to engage in transactional sex or remain in violent or abusive relationships due to their reliance on men in their communities to provide food for themselves and their children. There is an urgent need to prioritize food security programs for women living with HIV/AIDS and address broader gender-based inequities that are propelling women to engage in risky sexual behaviors based on hunger. Such interventions will play an important role in improving the health and well-being of people living with HIV/AIDS, and preventing HIV transmission.

Coping and the biosocial consequences of food insecurity in the 21st century

“…This effect was strongest among food insufficient females who had five times greater odds of inconsistent condom use when compared with food sufficient females. This effect maintained in a multivariable model that controlled for other economic and sociodemographic factors, and is consistent with ethnographic data linking food insecurity with inconsistent condom use (e.g., Miller et al, 2010).…”

“…A high prevalence of food insecurity (nearly 50%) has also been documented among PLWHA in San Francisco, CA and Vancouver B.C., Canada (Normen et al, 2005;Weiser et al, 2009b). On the other side of the causal model, at least theoretically, household food insecurity can increase an individual's risk of acquiring HIV by constraining options and thus promoting behavioral changes that increase risk of sexually transmitted infections (Weiser et al, 2007), the rapidity with which HIV converts to AIDS (Weiser et al, 2009b), and uptake and adherence to ART (Miller et al, 2010;Weiser et al, 2010). There is now research into each of these links (reviewed in Anema et al, 2009).…”

“…Qualitative studies primarily from sub-Saharan African have delimited the links between sex exchange, gender inequality, food insecurity, and high-risk sexual behaviors, as illustrated in a qualitative study among food insecure women in Uganda (Miller et al, 2010). Through analysis of semistructured data, the authors found that food insecurity and infectious disease were linked through pathways that increased one's (particularly women's) risk of acquiring an infectious disease though transactional sex, lack of control over condom use, and violent/abusive relationships.…”

Understanding the social determinants of TB and HIV in South Asia

“…A study based on the data from Demographic Health Survey (DHS, 2006) in India concluded that TB control strategies should be targeted to the poorest populations that are most at risk, and should address the most important determinants of disease such as malnutrition and living conditions [68]. In addition, since the problems are fundamentally interdisciplinary in nature, solutions should therefore come from joint collaboration among mass media, sociologists, anthropologists and epidemiologists.…”

Soup kitchen users' social representations of healthy eating associated with their household food security status

“…Studies have shown that income is the most important determinant of inequity, and income also explains food insecurity because it limits one's ability to acquire healthy and safe foods [26][27][28] . Nonetheless, other sociodemographic determinants must be investigated, such as household size, education level, race, and basic sanitation, among others 29 .…”