Food insecurity and the risk of HIV acquisition: findings from population-based surveys in six sub-Saharan African countries (2016–2017)

Abstract

ObjectiveTo assess the potential bidirectional relationship between food insecurity and HIV infection in sub-Saharan Africa.DesignNationally representative HIV impact assessment household-based surveys.SettingZambia, Eswatini, Lesotho, Uganda and Tanzania and Namibia.Participants112 955 survey participants aged 15–59 years with HIV and recency test results.MeasuresRecent HIV infection (within 6 months) classified using the HIV-1 limited antigen avidity assay, in participants with an unsuppressed viral load (>1000 copies/mL) and no detectable antiretrovirals; severe food insecurity (SFI) defined as having no food in the house ≥three times in the past month.ResultsOverall, 10.3% of participants lived in households reporting SFI. SFI was most common in urban, woman-headed households, and in people with chronic HIV infection. Among women, SFI was associated with a twofold increase in risk of recent HIV infection (adjusted relative risk (aRR) 2.08, 95% CI 1.09 to 3.97). SFI was also associated with transactional sex (aRR 1.28, 95% CI 1.17 to 1.41), a history of forced sex (aRR 1.36, 95% CI 1.11 to 1.66) and condom-less sex with a partner of unknown or positive HIV status (aRR 1.08, 95% CI 1.02 to 1.14) in all women, and intergenerational sex (partner ≥10 years older) in women aged 15–24 years (aRR 1.23, 95% CI 1.03 to 1.46). Recent receipt of food support was protective against HIV acquisition (aRR 0.36, 95% CI 0.14 to 0.88).ConclusionSFI increased risk for HIV acquisition in women by twofold. Heightened food insecurity during climactic extremes could imperil HIV epidemic control, and food support to women with SFI during these events could reduce HIV transmission.

Associations Between Mobility, Food Insecurity, and Transactional Sex Among Women in Cohabitating Partnerships: An Analysis From 6 African Countries 2016–2017

“…48,49 One study conducted using PHIA data found that food assistance receipt decreased the risk of both transactional sex and HIV infection in a pooled sample from African countries. 50 We found, however, that household food insecurity is not a significant confounder in the relationship between mobility and transactional sex, contrary to the intrinsic risk pathway posited by Cassels and colleagues. 23 It also does not exacerbate the association between mobility and transactional sex as an effect modifier.…”

“…48,49 One study conducted using PHIA data found that food assistance receipt decreased the risk of both transactional sex and HIV infection in a pooled sample from African countries. 50…”

Self-reported uptake of STI testing services among adolescents and young people aged 15–24 years: Findings from the Yathu Yathu cluster randomized trial in Lusaka, Zambia

“…Our risk factor analysis also found an association, among AGYW, between no food in the house in the past four weeks and ever STI-testing; similarly, there was evidence that AGYW residing in households with relatively less wealth were more likely to have ever STI tested. In population-based surveys conducted in six African countries, severe food insecurity, defined as having no food in the house more than three-times in the past month, was associated with an increased risk of HIV infection [ 37 ]. This increased risk was due, in part, to increased reliance on selling sex [ 37 ].…”

The state of the pediatric HIV epidemic in Lesotho: results from a population-based survey

“…A household wealth quintile was generated using principal components analysis of assets [26]. Occurrence and frequency of food insecurity was assessed in the last 4 weeks with food insufficiency defined as no food in the house 3 times or more [27]. Educational attainment was based on the highest level attended.…”