Household Food Insecurity as Mediator of the Association Between Internalized Stigma and Opportunistic Infections

Abstract

Internalized HIV stigma can affect health outcomes, but the mechanism underlying this relationship is poorly understood. We investigated the potential pathways for the association between internalized stigma and opportunistic infections (OIs) among women living with HIV in rural India. We conducted a cross-sectional study involving in-person interviews with 600 participants. We modeled two outcome variables, total number of OIs and fungal dermatoses, which was the most frequently reported OI. Causal mediation analysis was performed to estimate the total effect, direct effect, and indirect effect through mediators while controlling for confounders. Food insecurity was a strong mediator of the association between internalized stigma and the number of OIs (70% of the total effect) and fungal dermatoses (83% of the total effect), while the indirect effect of stigma through adherence was minimal for both outcomes. Household food insecurity may be an important mediator of the impact of HIV-related stigma on opportunistic infections.

Social Support, Food Insecurity, and HIV Stigma Among Men Living with HIV in Rural Southwestern Uganda: A Cross-Sectional Analysis

“…We also found a statistically significant association between HIV stigma and severe food insecurity, which is similar to what has been reported in the previous research. 66 HIV stigma predisposes HIV-affected households to food insecurity through limited social interaction and self-isolation by people living with HIV due to feelings of shame, guilt and self-devaluation. 65 , 66 Previous studies show that HIV stigma is associated with higher levels of loneliness and social alienation, which disrupts their social relationships.…”

“… 66 HIV stigma predisposes HIV-affected households to food insecurity through limited social interaction and self-isolation by people living with HIV due to feelings of shame, guilt and self-devaluation. 65 , 66 Previous studies show that HIV stigma is associated with higher levels of loneliness and social alienation, which disrupts their social relationships. 18 , 89 Avoidance of social interaction in relation to HIV stigma narrows economic productivity due to the affected people missing out on employment opportunities, inability to engage in income generating activities and limited access to financial support.…”

“…The stigma scale we used did not differentiate between internalized, enacted, and anticipated HIV stigma, which could have affected the interpretation of our findings in relation to the relationship between HIV stigma and food insecurity found in our study, given that existing literature points to a stronger association between internalized HIV stigma and food insecurity. 66 Nonetheless, the Berger scale used in this study captures different aspects of HIV stigma including fear of disclosure, public negative attitudes, and self-image under which aspects of internalizing stigma are captured. 70 Thirdly, we did not explore for masculinity norms which have been pointed out as a major barrier to HIV care among men living with HIV in most sub-Saharan settings and this could have had an impact on the interpretation of findings in relation to the associations between HIV stigma and food insecurity.…”

“… 54 , 62–64 The relationship between HIV stigma and food insecurity has been linked to social distance and reduced involvement in social activities that come when people test positive for HIV, which impacts the ability to access tangible support, paid labor, and cash loans that would enable them to access food. 53 , 65 , 66 Additionally, HIV is associated with morbidity which affects the ability of adults living with HIV to work on their farms or engage in other economic activities which leads to food insecurity at household level. 67 , 68 …”

High magnitude of food insecurity and malnutrition among people living with HIV/AIDS in Ethiopia: A call for integration of food and nutrition security with HIV treatment and care Programme

“…The result of this finding is also consistent with the longitudinal cohort study conducted in Uganda, where food insecurity was found to be associated with worse OIs (Weiser et al, 2012b). Likewise, food insecurity was reported as a mediating factor for recurrent episodes OIs among PLHIV in India (Shin et al, 2018).…”