HIV, Tuberculosis, and Food Insecurity in Africa—A Syndemics-Based Scoping Review

Abstract

The double burden of HIV/AIDS and tuberculosis (TB), coupled with endemic and problematic food insecurity in Africa, can interact to negatively impact health outcomes, creating a syndemic. For people living with HIV/AIDS (PWH), food insecurity is a significant risk factor for acquiring TB due to the strong nutritional influences and co-occurring contextual barriers. We aim to synthesize evidence on the syndemic relationship between HIV/AIDS and TB co-infection and food insecurity in Africa. We conducted a scoping review of studies in Africa that included co-infected adults and children, with evidence of food insecurity, characterized by insufficient to lack of access to macronutrients. We sourced information from major public health databases. Qualitative, narrative analysis was used to synthesize the data. Of 1072 articles screened, 18 articles discussed the syndemic effect of HIV/AIDS and TB co-infection and food insecurity. Reporting of food insecurity was inconsistent, however, five studies estimated it using a validated scale. Food insecure co-infected adults had an average BMI of 16.5–18.5 kg/m2. Negative outcomes include death (n = 6 studies), depression (n = 1 study), treatment non-adherence, weight loss, wasting, opportunistic infections, TB-related lung diseases, lethargy. Food insecurity was a precursor to co-infection, especially with the onset/increased incidence of TB in PWH. Economic, social, and facility-level factors influenced the negative impact of food insecurity on the health of co-infected individuals. Nutritional support, economic relief, and psychosocial support minimized the harmful effects of food insecurity in HIV–TB populations. Interventions that tackle one or more components of a syndemic interaction can have beneficial effects on health outcomes and experiences of PWH with TB in Africa.

Mental Health Challenges and the Associated Factors in Women Living with HIV Who Have Children Living with HIV in Indonesia: A Qualitative Study

“…For these mothers, having a child diagnosed with HIV doubled the existing burden as it shifted their focus and attention from themselves to their child’s health, and made them feel even more stressed, scare, and uncertain. This enriches current evidence about double burdens people living with HIV experience, from things including: co-infection, malnutrition, and food insecurity [ 40 , 41 ]. Mothering CLHIV requires an enormous amount of love, devotion, and care, and takes an emotional and physical toll, especially under difficult circumstances when support is scarce.…”

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

“…[14][15][16] The HIV pandemic has had a bidirectional link to food insecurity, 17 as the associated health consequences can drive lower productivity and decreased labour mobility, whereas food insecurity can increase HIV risk behaviours, disruptions in care and higher mortality. [15][16][17][18][19] The impact has been assumed to be gendered in that women are particularly vulnerable to income shocks and to disruption to access to health resources. 20 Food insecurity has also been associated with lower efficacy of antiretroviral treatment (ART) due to drug malabsorption or decreased adherence, with virological failure.…”

Mental health challenges and the associated factors in HIV-positive women who have children living with HIV in Indonesia: A qualitative study

“…For these mothers, having a child diagnosed with HIV doubled the existing burden as it shifted their focus and attention from themselves to their child's health, and made them feel even more stressed, scared and uncertain. This enriches current evidence about double burdens PLHIV experience, from things including; co-infection, malnutrition and food insecurity [31,32]. Mothering CLHIV requires an enormous amount of love, devotion, and care, and takes an emotional and physical toll, especially under difficult circumstances when support is scarce.…”