Food Insecurity is Associated with Incomplete HIV RNA Suppression Among Homeless and Marginally Housed HIV-infected Individuals in San Francisco

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

“…15,34,56 Many of the same factors that predispose individuals to food insecurity-including poverty, mental illness, and substance use-also put them at risk for HIV infection 50 and predict poor overall health among HIVinfected adults. 57 The prevalence of food insecurity among HIV-infected homeless and marginally housed individuals is higher than that seen in a nationally representative sample of non-HIV-infected homeless persons, where the prevalence is estimated at 25 %-32 %, 30 and higher than the prevalence of food insecurity in the general US population, which is estimated to be 15 %.…”

“…40 This is consistent with studies showing that impacts of food insecurity on HIV-related health outcomes, including immunologic and virologic outcomes, physical health status, and other measures of morbidity, are quite similar in resource-rich and resource-poor countries. 33,34,[39][40][41]59 Such consistency across different settings suggests that food insecurity is a robust and seemingly universal predictor of worse outcomes, which may contribute to the increased need for acute care services.…”

“…28,29 Cross-sectional studies among non-HIV infected individuals in the US found that food insecurity is associated with postponing needed medications and care, increased emergency department use, and increased hospitalizations. 30,31 In cross-sectional studies among HIV-infected individuals in the US and Canada, food insecurity has been associated with decreased immunologic and virologic responses, [32][33][34][35] and worse mental health, even when controlling for other markers of socioeconomic status such as income, education, and employment. [35][36][37] Qualitative and cross-sectional quantitative studies in resource-rich and resource-poor countries have found food insecurity is an important cause of ART non-adherence and treatment interruptions.…”

“…[35][36][37] Qualitative and cross-sectional quantitative studies in resource-rich and resource-poor countries have found food insecurity is an important cause of ART non-adherence and treatment interruptions. 32,34,38 A few longitudinal studies have reported negative health impacts of food insecurity among HIVinfected individuals, including worse physical health status and increased opportunistic infections in Uganda, lower CD4 counts in a study in the Boston area, and higher risk of mortality in British Columbia. [39][40][41] There is little understanding of how food insecurity impacts patterns of health-care utilization among HIVinfected individuals, particularly in resource-rich countries without universal health care such as the US.…”

The Enabling Effect of Food Assistance in Improving Adherence and/or Treatment Completion for Antiretroviral Therapy and Tuberculosis Treatment: A Literature Review

“…Food insecurity is one of the multiple barriers that individuals face in initiating and adhering to long-term medical therapies such as ART and DOTS, especially in resourcelimited settings [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Other patient-related barriers include the complexity of the medication regimen [18], emotional distress [7], illness costs to households [19], stigma [20], health beliefs and poverty [4], limited knowledge of the disease [21], difficulty remembering [22], intentional non-adherence due to adverse drug reactions [23] and harmful use of alcohol [24].…”