Intersections of food insecurity, violence, poor mental health and substance use among US women living with and at risk for HIV: Evidence of a syndemic in need of attention

Abstract

Background Food insecurity and intimate partner violence (IPV) are associated with suboptimal HIV prevention and treatment outcomes, yet limited research has explored how food insecurity and IPV intersect to influence HIV-related behaviors. To fill this gap, we conducted a qualitative study with women living with or at risk for HIV in the United States. Methods We conducted 24 in-depth interviews with women enrolled in the San Francisco and Atlanta sites of the Women’s Interagency HIV study (WIHS). Participants were purposively sampled so half were living with HIV and all reported food insecurity and IPV in the past year. Semi-structured interviews explored experiences with food insecurity and IPV, how these experiences might be related and influence HIV risk and treatment behaviors. Analysis was guided by an inductive-deductive approach. Results A predominant theme centered on how food insecurity and IPV co-occur with poor mental health and substance use to influence HIV-related behaviors. Women described how intersecting experiences of food insecurity and IPV negatively affected their mental health, with many indicating using substances to “feel no pain”. Substance use, in turn, was described to perpetuate food insecurity, IPV, and poor mental health in a vicious cycle, ultimately facilitating HIV risk behaviors and preventing HIV treatment adherence. Conclusions Food insecurity, IPV, poor mental health and substance use intersect and negatively influence HIV prevention and treatment behaviors. Findings offer preliminary evidence of a syndemic that goes beyond the more widely studied “SAVA” (substance use, AIDS, and violence) syndemic, drawing attention to additional constructs of mental health and food insecurity. Quantitative research must further characterize the extent and size of this syndemic. Policies that address the social and structural drivers of this syndemic, including multi-level and trauma-informed approaches, should be implemented and evaluated to assess their impact on this syndemic and its negative health effects.

Associations between female birth sex and risk of chronic kidney disease development among people with HIV in the USA: A longitudinal, multicentre, cohort study

“… 73 Additionally, substance use among WWH has been consistently associated with failure to achieve viral suppression. 74 , 75 , 76 As active viraemia is a known risk factor for kidney disease progression, 77 these may represent meaningful points of intervention as actions taken to reduce HIV stigma and eliminate barriers to clinical attendance may improve retention in care, ART adherence, and chronic disease management. Consequently, interpersonal and societal factors may compound upon and interact with each other to increase risk factors for CKD and perhaps for subsequent CKD risk.…”

Sex Differences in Non-AIDS Comorbidities Among People With Human Immunodeficiency Virus

“…Emerging literature suggests that traditional risk factors such as smoking, substance use, race, BMI, and social determinants of health may impact aging-related comorbidity development more so than HIV-related indices such as CD4 + count or HIV-1 viremia [ 10 , 43 , 123 ]. Physiological effects of substance use may also differ by sex [ 124 , 125 ]. Finally, structural inequities including sex- and gender-biased research compound sociobehavioral vulnerabilities and biologic differences, thereby exacerbating worsened health outcomes experienced by women [ 124 ].…”

Mental Health Mediates the Association Between Gender-Based Violence and HIV Treatment Engagement in US Women

“…In a qualitative study among WLHIV in the United States, the stress of being food insecure, coupled with experiences of violence, led to a low appetite and made it difficult to take HIV medications with food. 37…”

“…In a qualitative study among WLHIV in the United States, the stress of being food insecure, coupled with experiences of violence, led to a low appetite and made it difficult to take HIV medications with food. 37 To effectively reduce the impact of GBV on engagement in care, several gaps in knowledge must be addressed. Although the mental health pathways linking GBV to suboptimal engagement in care have been described, 8,14,37,38 few studies have explicitly tested whether poor mental health mediates the association between GBV and engagement in care.…”

“…37 To effectively reduce the impact of GBV on engagement in care, several gaps in knowledge must be addressed. Although the mental health pathways linking GBV to suboptimal engagement in care have been described, 8,14,37,38 few studies have explicitly tested whether poor mental health mediates the association between GBV and engagement in care. Moreover, qualitative research has highlighted a complex relationship between food insecurity, GBV, and HIV care engagement, 37 yet no studies have tested whether food insecurity moderates the association between GBV and adherence-which could inform who should be prioritized for interventions.…”