The social context of food insecurity among persons living with HIV/AIDS in rural Uganda

Abstract

HIV/AIDS and food insecurity are two of the leading causes of morbidity and mortality in sub-Saharan Africa, with each heightening the vulnerability to, and worsening the severity of, the other. Less research has focused on the social determinants of food insecurity in resource-limited settings, including social support and HIV-related stigma. In this study, we analyzed data from a cohort of 456 persons from the Uganda AIDS Rural Treatment Outcomes study, an ongoing prospective cohort of persons living with HIV/AIDS (PLWHA) initiating HIV antiretroviral therapy in Mbarara, Uganda. Quarterly data were collected by structured interviews. The primary outcome, food insecurity, was measured with the Household Food Insecurity Access Scale. Key covariates of interest included social support, internalized HIV-related stigma, HIV-related enacted stigma, and disclosure of HIV serostatus. Severe food insecurity was highly prevalent overall (38%) and more prevalent among women than among men. Social support, HIV disclosure, and internalized HIV-related stigma were associated with food insecurity; these associations persisted after adjusting for household wealth, employment status, and other previously identified correlates of food insecurity. The adverse effects of internalized stigma persisted in a lagged specification, and the beneficial effect of social support further persisted after the inclusion of fixed effects. International organizations have increasingly advocated for addressing food insecurity as part of HIV/AIDS programming to improve morbidity and mortality. This study provides quantitative evidence on social determinants of food insecurity among PLWHA in resource-limited settings and suggests points of intervention. These findings also indicate that structural interventions to improve social support and/or decrease HIV-related stigma may also improve the food security of PLWHA.

Food insecurity and undernutrition in treated HIV patients a (post-) conflict setting: A cross sectional study from Goma, Eastern Democratic Republic of Congo

“…Many studies in Africa and elsewhere have shown that households with HIV have a higher risk of household food insecurity [18,[27][28][29][30].However, the prevalence reported in our study by far outstrips the documented food insecurity prevalence in Kinshasa [18]. The particular context of insecurity in the region can provide an explanation; the city of Goma has been affected by civil war for many years.…”

Tailored Nutrition Education and Food Assistance Improve Adherence to HIV Antiretroviral Therapy: Evidence from Honduras

“…We included demographic, clinical, health, and socioeconomic characteristics that the literature suggests may confound the relationship between receiving a nutritional intervention and adherence (27–30). …”

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

“…However, HIV, which is concentrated among the poor, continues to be heavily stigmatized in much of sub-Saharan Africa; this stigma can prevent HIV-affected households from drawing on informal support (56). For example, in a longitudinal study among HIV-infected ARTtreated individuals in rural Uganda, both internalized HIV stigma (internalized negative views about HIV/AIDS by PLWHA) and enacted HIV stigma (experiences of discrimination related to HIV status) were strongly associated with food insecurity, which suggests that HIV stigma may contribute to the negative effects of HIV/AIDS on food security (57).…”