Food insecurity is associated with HIV, sexually transmitted infections and drug use among men in the United States

Abstract

Objective To examine the population-level association between food insecurity, HIV risk factors, and HIV serostatus among men, the group representing the majority of HIV diagnoses in the United States (US). Design Cross-sectional secondary data analysis using the National Health and Nutrition Examination Survey (NHANES) 1999-2012, a nationally representative survey of the civilian non-institutionalized US population. Methods Logistic regression with design weights and complex survey commands was used to estimate nationally-representative associations between food insecurity and HIV serostatus (primary outcome), herpes simplex virus 2 (HSV-2), self-reported STIs, and past-year illicit drug use among men, adjusting for potential confounders. Food security was measured using the 18-item Household Food Security Survey. Results We analyzed data for 9150 men representing 61 million individuals in the US. Unadjusted HIV prevalence was 1.5% among food insecure men, compared to 0.4% among food secure men (p<0.001). In adjusted models, food insecure men had over 2 times higher odds of HIV seropositivity compared to food secure men (adjusted odds ratio (AOR)=2.10; 95% CI 1.01 - 4.37; p<0.05). Food insecurity was associated with higher odds of HSV-2 seropositivity (AOR=1.28; 95% CI 1.04 - 1.57; p<0.05), self-reported STIs (AOR=1.54; 95% CI 1.08 - 2.20; p<0.05), and illicit drug use (AOR=1.57; 95% CI 1.14 - 2.15; p<0.01). Results were robust to sensitivity analyses restricted to lower incomes. Conclusions Food insecurity is associated with prevalent HIV, STIs and illicit drug use among men in the US. Further research is needed to establish whether and through what mechanisms improved food security may help prevent new HIV infections.

Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health

“…Food insecurity increases the risk of acquisition of and poor outcomes associated with both infectious and non-communicable diseases [4,5]. In HIV, food insecurity is associated with increased risk of HIV acquisition [6] and transmission [7,8], poor medication adherence [9,10], worse immunologic [10,11] and virologic outcomes [10,12,13], morbidity [14], and mortality [15]. In diabetes, food insecurity is associated with increased risk of type 2 diabetes mellitus (T2DM) [4], poorer diabetes self-management [16,17], poorer glycemic (i.e., blood sugar) control [4], and increased hypoglycemic events [18].…”

Smoking Predicts Food Insecurity Severity among Persons Living with HIV

“…Covariates included demographic characteristics and known confounders of food insecurity, including depressive symptoms, substance use, and quality of life related to mental health and physical health [12,13,23]. Depressive symptoms were measured using the Beck Depression Inventory-II [26], a 21-item self-report measure assessing the severity of depressive symptoms in reference to the past two weeks.…”

“…Interacting with these structural and social factors, substance use oftentimes co-occurs with the experience of food insecurity [9–12]. For example, in a study of 250 PLHIV who were experiencing homelessness and unstable housing, recent crack cocaine use was independently associated with two-fold greater odds of food insecurity [13].…”

“…The intersection of food insecurity and substance use is an important area for further research, as the two are likely to be bi-directionally associated. Substance use places competing demands on limited resources which could thereby exacerbate food insecurity [14,15], yet the experience of food insecurity has also been found to be associated with increased prevalence of substance use [12]. In a study of 503 PLHIV using substances, those experiencing food and housing insecurity were more likely to engage in poor coping strategies, such as diversion of their medications, in part to manage the immediate stressors of daily living in impoverished conditions [10].…”

“…We hypothesized that cigarette use would independently predict food insecurity severity after adjusting for key confounders such as depressive symptoms, substance use, and quality of life [12,13,23]. …”