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Zubizarreta D, Wirtz AL, Humes E, Cooney EE, Stevenson M, Althoff KN, Radix AE, Poteat T, Beyrer C, Wawrzyniak AJ, Mayer KH, Reisner SL. Food Insecurity Is High in a Multi-Site Cohort of Transgender Women Vulnerable to or Living with HIV in the Eastern and Southern United States: Baseline Findings from the LITE Cohort. Nutrients 2024; 16:707. [PMID: 38474837 DOI: 10.3390/nu16050707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/14/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
The prevalence and correlates of food insecurity-the unavailability of food and limited access to it-have not been adequately considered among transgender women (TW), particularly alongside other health-related conditions burdening this population, such as HIV infection. This study examined the prevalence and correlates of food insecurity among TW. Between 2018 and 2020, 1590 TW in the Eastern and Southern U.S. completed a multi-site baseline assessment (socio-behavioral survey and HIV testing). Descriptive statistics were calculated and multivariable Poisson models with robust error variance were used to estimate prevalence ratios and 95% confidence intervals for correlates of food insecurity (dichotomized as sometimes-to-always vs. seldom-to-never running out of food). Eighteen percent of TW were living with HIV and nearly half of participants (44%) reported food insecurity. Correlates of food insecurity included being Black, multiracial, or another race/ethnicity; having < college education, low income, unstable housing, and high anticipated discrimination; and a history of sex work and sexual violence (all p < 0.05). Food insecurity was highly prevalent among TW. Current programs to provide food support do not adequately meet the needs of TW. HIV pr evention and care programs may benefit from addressing food insecurity.
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Affiliation(s)
- Dougie Zubizarreta
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Erin E Cooney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Meg Stevenson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Asa E Radix
- Callen-Lorde Community Health Center, New York, NY 10011, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Tonia Poteat
- Division of Healthcare in Adult Populations, School of Nursing, Duke University, Durham, NC 27710, USA
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | | | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
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Burns PA, Mutunga C. Addressing the Impact of Climate Change on Sexual and Reproductive Health Among Adolescent Girls and Young Women in Low- and Middle-Income Countries. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:GHSP-D-23-00374. [PMID: 38365281 PMCID: PMC10906547 DOI: 10.9745/ghsp-d-23-00374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/23/2024] [Indexed: 02/18/2024]
Abstract
There is an urgent need to better understand the role of climate change on sexual and reproductive health outcomes, particularly among adolescent girls and young women in low- and middle-income countries. Stakeholders at all levels should apply a rights-based, gendered approach to climate action and adaptation.
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Affiliation(s)
- Paul A Burns
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA.
- U.S. Agency for International Development, Bureau for Global Health, Office of Population and Reproductive Health, Division of Research, Technology and Utilization, Washington, DC
- American Association for the Advancement of Science, Washington, DC
| | - Clive Mutunga
- BUILD (Building Capacity for Integrated Family Planning & Reproductive Health and Population, Environment and Development Action), The African Institute for Development for Policy, Lilongwe, Malawi
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3
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Shangani S, Masa R, Zimba M, Zimba G, Operario D. Food insecurity and depressive symptoms among young people living with HIV in Eastern Zambia. Int J STD AIDS 2024; 35:25-32. [PMID: 37707955 DOI: 10.1177/09564624231201917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Background: Mental health problems are common among people living with HIV/AIDS and contribute to poor HIV-related outcomes, including AIDS-related mortality. We examined the association between severe food insecurity and depressive symptoms in young people living with HIV (YPLH) in Zambia. Methods: We sampled 120 youth living with HIV aged 18-21 years in the Eastern Province of Zambia. Household food insecurity was measured using the Household Food Insecurity Access Scale (HFIAS). Mental health was assessed using the Children's Depression Inventory-Short Form. We fitted linear regression models to assess whether food insecurity is associated with depressive symptoms. Results: The mean age was 19 years, and 63% were female. Overall, 43% were severely food insecure. After adjusting for sociodemographic variables and other confounders, severely food insecure participants were more likely to report depressive symptoms (β = 0.81, 95% Confidence Interval [CI] 0.07-1.55) and engagement in sex work (β = 1.78, 95% CI 0.32-3.25). Conclusion: Almost half of the sample reported severe food insecurity which was associated with depressive symptoms. Interventions aimed at improving food insecurity may have beneficial effects on mental health and HIV outcomes among young people living with HIV in resource-limited settings.
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Affiliation(s)
- Sylvia Shangani
- School of Public Health, Department of Community Health Sciences, Boston University, Boston, MA, USA
| | - Rainier Masa
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
| | - Mathias Zimba
- Rising Fountains Development Program, Lundazi, Zambia
| | - Gilbert Zimba
- Rising Fountains Development Program, Lundazi, Zambia
| | - Don Operario
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Wegermann K, Moylan C, Naggie S. Fatty Liver Disease: Enter the Metabolic Era. Curr HIV/AIDS Rep 2023; 20:405-418. [PMID: 37882965 DOI: 10.1007/s11904-023-00669-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to summarize the recent literature linking HIV to metabolic dysfunction-associated steatotic liver disease (MASLD). This is a pressing issue due to the scale of the MASLD epidemic and the urgent need for preventive and therapeutic strategies for MASLD in PWH. RECENT FINDINGS The prevalence of MASLD in PWH is higher than previously appreciated, approaching 50% depending on the population and definition of MASLD. MASLD in PWH is likely multifactorial due to risk factors present in the general population such as metabolic syndrome, and features unique to HIV including systemic inflammation and ART. Statin therapy results in a significant reduction in major adverse cardiovascular events in PWH. PWH are at high risk for MASLD. Screening PWH with metabolic syndrome features could enable earlier interventions to reduce morbidity and mortality associated with MASLD in PWH.
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Affiliation(s)
- Kara Wegermann
- Division of Gastroenterology, Department of Medicine, Duke University Health System, Durham, NC, USA
| | - Cynthia Moylan
- Division of Gastroenterology, Department of Medicine, Duke University Health System, Durham, NC, USA
- Department of Medicine, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Susanna Naggie
- Department of Medicine, Durham Veterans Affairs Medical Center, Durham, NC, USA.
- Division of Infectious Diseases, Department of Medicine, Duke University Health System, Durham, NC, USA.
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5
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Celeste-Villalvir A, Then-Paulino A, Armenta G, Jimenez-Paulino G, Palar K, Wallace DD, Derose KP. Exploring feasibility and acceptability of an integrated urban gardens and peer nutritional counselling intervention for people with HIV in the Dominican Republic. Public Health Nutr 2023; 26:3134-3146. [PMID: 37905447 PMCID: PMC10755388 DOI: 10.1017/s1368980023002264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/04/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Food security interventions with people living with HIV (PLHIV) are needed to improve HIV outcomes. This process evaluation of a pilot intervention involving urban gardening and peer nutritional counselling with PLHIV assesses feasibility, acceptability and implementation challenges to inform scale-up. DESIGN Mixed methods were used, including quantitative data on intervention participation and feasibility and acceptability among participants (n 45) and qualitative data from a purposive sample of participants (n 21). Audio-recorded interviews were transcribed and coded using a codebook developed iteratively. SETTING An HIV clinic in the northwest-central part of the Dominican Republic. RESULTS The intervention was feasible for most participants: 84 % attended a garden workshop and 71 % established an urban garden; 91 % received all three core nutritional counselling sessions; and 73 % attended the cooking workshop. The intervention was also highly acceptable: nearly, all participants (93-96 %) rated the gardening as 'helpful' or 'very helpful' for taking HIV medications, their mental/emotional well-being and staying healthy; similarly, high percentages (89-97 %) rated the nutrition counselling 'helpful' or 'very helpful' for following a healthy diet, reducing unhealthy foods and increasing fruit/vegetable intake. Garden barriers included lack of space and animals/pests. Transportation barriers impeded nutritional counselling. Harvested veggies were consumed by participants' households, shared with neighbours and family, and sold in the community. Many emphasised that comradery with other PLHIV helped them cope with HIV-related marginalisation. CONCLUSION An urban gardens and peer nutritional counselling intervention with PLHIV was feasible and acceptable; however, addressing issues of transportation, pests and space is necessary for equitable participation and benefit.
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Affiliation(s)
- Alane Celeste-Villalvir
- University of Massachusetts Amherst, Department of Health Promotion and Policy, Amherst, MA01003, USA
| | - Amarilis Then-Paulino
- Universidad Autónoma de Santo Domingo, Facultad de Ciencias de la Salud, Av. Alma Mater, Santo Domingo, Dominican Republic
| | - Gabriela Armenta
- RAND Corporation and Pardee RAND Graduate School, Santa Monica, CA90401, USA
| | - Gipsy Jimenez-Paulino
- Universidad Autónoma de Santo Domingo, Facultad de Ciencias de la Salud, Av. Alma Mater, Santo Domingo, Dominican Republic
| | - Kartika Palar
- University of California, San Francisco, Department of Medicine, San Francisco, CA94143, USA
| | - Deshira D Wallace
- University of North Carolina at Chapel Hill, Department of Health Behavior, Chapel Hill, NC27599, USA
| | - Kathryn P Derose
- University of Massachusetts Amherst, Department of Health Promotion and Policy, Amherst, MA01003, USA
- RAND Corporation and Pardee RAND Graduate School, Santa Monica, CA90401, USA
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Ogunbajo A, Bogart LM, Mutchler MG, Klein DJ, Lawrence SJ, Goggin K, Wagner GJ. Unmet Social Needs are Associated with Lower Adherence to Antiretroviral Therapy (ART) Medication Among a Sample of Black People Living with HIV (PLHIV). AIDS Behav 2023; 27:3651-3660. [PMID: 37195472 PMCID: PMC10191094 DOI: 10.1007/s10461-023-04079-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 05/18/2023]
Abstract
The current study examined the prevalence and typology of unmet needs and the association between unmet needs and HIV antiretroviral therapy (ART) medication adherence among a sample of Black people living with HIV(PLHIV) (N = 304) in Los Angeles, CA. We found a high prevalence of unmet needs, with 32% of participants reporting having two or more unmet needs. The most common unmet needs category was basic benefits needs (35%), followed by subsistence needs (33%), and health needs (27%). Significant correlates of unmet needs included food insecurity, history of homelessness, and history of incarceration. A greater number of unmet needs and any unmet basic benefits needs were each significantly associated with lower odds of HIV ART medication adherence. These findings provide further evidence linking the social determinants of health and social disenfranchisement to ART medication adherence among Black PLHIV.
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Affiliation(s)
| | - Laura M Bogart
- RAND Corporation, Santa Monica, CA, United States of America
| | - Matt G Mutchler
- APLA Health & Wellness, Los Angeles, CA, United States of America
- California State University Dominguez Hills, Carson, CA, United States of America
| | - David J Klein
- RAND Corporation, Santa Monica, CA, United States of America
| | - Sean J Lawrence
- APLA Health & Wellness, Los Angeles, CA, United States of America
| | - Kathy Goggin
- Health Services and Outcome Research, Children's Mercy Kansas City and University of Missouri - Kansas City Schools of Medicine and Pharmacy, Kansas City, MO, United States of America
| | - Glenn J Wagner
- RAND Corporation, Santa Monica, CA, United States of America
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Joy P, Hammond C, Hammond B, Clarke A, Mannette J, Hamilton-Hinch BA, Grant S. Disciplined appetites: Reimagining food and nutrition programs for people living with HIV and AIDS. Nutr Diet 2023; 80:521-529. [PMID: 36941202 DOI: 10.1111/1747-0080.12806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/20/2022] [Accepted: 03/01/2023] [Indexed: 03/23/2023]
Abstract
AIMS Medical nutrition therapy is recommended for people living with HIV/AIDS to improve health and wellness; however, there is a lack of food and nutrition programs for people living with HIV/AIDS in Nova Scotia, Canada. The aim of this study was to explore the beliefs, values, and experiences of people living with HIV/AIDS in relation to food and nutrition programs. METHODS A critical social theory lens with two disciplinary contexts: critical health geography and critical dietetics guided this research. Semi-structured interviews were conducted with 12 people living with HIV/AIDS and analysed for themes. RESULTS The three main themes were identified: (1) intersections of social determinants of health, wellness, and food security; (2) discursive shaping of food and nutrition in relation to HIV; and (3) the dynamic nature of HIV care. CONCLUSIONS Participants offered recommendations on how food and nutrition programs might be reimagined to be more accessible, inclusive, and effective for people living with HIV/AIDS.
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Affiliation(s)
- Phillip Joy
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Chad Hammond
- University of Saskatchewan, College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Brianna Hammond
- Nascent Knowledge Consulting, Saskatoon, Saskatchewan, Canada
| | - Abigail Clarke
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Jessica Mannette
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | | | - Shannan Grant
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
- Departments of Pediatrics, Obstetrics, and Gynaecology, IWK Health, Halifax, Nova Scotia, Canada
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8
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Reddon H, Fairbairn N, Grant C, Milloy MJ. Experiencing homelessness and progression through the HIV cascade of care among people who use drugs. AIDS 2023; 37:1431-1440. [PMID: 37070552 PMCID: PMC10330029 DOI: 10.1097/qad.0000000000003570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To investigate the longitudinal association between periods of homelessness and progression through the HIV cascade of care among people who use drugs (PWUD) with universal access to no-cost HIV treatment and care. DESIGN Prospective cohort study. METHODS Data were analysed from the ACCESS study, including systematic HIV clinical monitoring and a confidential linkage to comprehensive antiretroviral therapy (ART) dispensation records. We used cumulative link mixed-effects models to estimate the longitudinal relationship between periods of homelessness and progression though the HIV cascade of care. RESULTS Between 2005 and 2019, 947 people living with HIV were enrolled in the ACCESS study and 304 (32.1%) reported being homeless at baseline. Homelessness was negatively associated with overall progression through the HIV cascade of care [adjusted partial proportional odds ratio (APPO) = 0.56, 95% confidence interval (CI): 0.49-0.63]. Homelessness was significantly associated with lower odds of progressing to each subsequent stage of the HIV care cascade, with the exception of initial linkage to care. CONCLUSIONS Homelessness was associated with a 44% decrease in the odds of overall progression through the HIV cascade of care, and a 41-54% decrease in the odds of receiving ART, being adherent to ART and achieving viral load suppression. These findings support calls for the integration of services to address intersecting challenges of HIV, substance use and homelessness among marginalized populations such as PWUD.
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Affiliation(s)
- Hudson Reddon
- British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - M-J Milloy
- British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Toska E, Zhou S, Chen-Charles J, Gittings L, Operario D, Cluver L. Factors Associated with Preferences for Long-Acting Injectable Antiretroviral Therapy Among Adolescents and Young People Living with HIV in South Africa. AIDS Behav 2023; 27:2163-2175. [PMID: 36622486 PMCID: PMC9827015 DOI: 10.1007/s10461-022-03949-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/10/2023]
Abstract
Long-acting injectable anti-retroviral therapy (LAART) may overcome barriers to long-term adherence and improve the survival of adolescents and young people living with HIV (AYLHIV). Research on the acceptability of LAART for this age-group is limited. We asked 953 AYLHIV about their preferred (theoretical) ART mode of delivery (pill, injectable, or other) in 2017-2018, before LAART was available or known to AYLHIV in South Africa. One in eight (12%) AYLHIV preferred LAART over single or multiple pill regimens. In multivariate analyses, six factors were associated with LAART preference: medication stock-outs (aOR = 2.56, 95% CI 1.40-4.68, p = 0.002), experiencing side-effects (aOR = 1.84, 95% CI 1.15-2.97, p = 0.012), pill-burden (aOR = 1.88, 95% CI 1.20-2.94, p = 0.006), past-year treatment changes (aOR = 1.63, 95% CI 1.06-2.51, p = 0.025), any HIV stigma (aOR = 2.22, 95% CI 1.39-3.53, p ≤ 0.001) and recent ART initiation (aOR = 2.02, 95% CI 1.09-3.74, p = 0.025). In marginal effects modelling, 66% of adolescents who experienced all factors were likely to prefer LAART, highlighting the potential high acceptability of LAART among adolescents and young people living with HIV struggling to adhere and have good HIV treatment outcomes. Adolescent boys who reported high ART pill burden were more likely to prefer LAART than their female peers in moderation analyses, suggesting that LAART may be particularly important to improve treatment outcomes among male AYLHIV as they become older. Adding LAART to existing treatment options for AYLHIV, particularly higher risk groups, would support AYLHIV to attain and sustain viral suppression-the third 95, and reduce their risk of AIDS-related mortality.
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Affiliation(s)
- Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.
- Department of Sociology, University of Cape Town, Cape Town, South Africa.
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
- Centre for Social Science Research, Leslie Social Sciences Building, University of Cape Town, 4.89, Rondebosch, Cape Town, 7700, South Africa.
| | - Siyanai Zhou
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jenny Chen-Charles
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Lesley Gittings
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- School of Health Studies, Faculty of Health Sciences, Western University, London, Canada
| | - Don Operario
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, UK
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Fox A, Kim H. HIV policy legacies, pandemic preparedness and policy effort to address COVID-19. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001767. [PMID: 37363903 DOI: 10.1371/journal.pgph.0001767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 05/22/2023] [Indexed: 06/28/2023]
Abstract
That the world was unprepared for a major infectious disease outbreak is now readily apparent to all credible observers. However, some countries were more prepared than others and we have seen a variety of responses to COVID-19 emerge across nations. While recognizing that the sources of variation in country responses to COVID-19 are many and varied, in this study we seek to examine how policy legacies from national responses to HIV have influenced countries' responses to COVID-19. The aim of this study was to examine whether countries with a more conducive HIV policy environment were better prepared for COVID-19 and have therefore had more preemptive and rights-based responses. Using data from the Oxford Covid-19 Government Response Tracker, we develop measures of country effort to respond to COVID-19 including early containment and closure policies, prevention policies, economic policies, and health system policies. We combine this with data from the HIV Policy Lab and correlate overall and disaggregated country HIV Policy scores with COVID-19 Policy scores. We find that the COVID-19 Containment and Closure Measures Index was negatively correlated with supportive social policies related to HIV in the early stages of the pandemic, but the association did not persist as time went on. The COVID-19 Economic Support Measures had prolonged positive associations with supportive social policies related to HIV and negative association with clinical and treatment policies. Countries with stronger structural responses to HIV have been less inclined towards involuntary measures and more prepared for the social and economic elements of COVID-19 pandemic response.
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Affiliation(s)
- Ashley Fox
- Department of Public Administration and Policy, Rockefeller College of Public Affairs and Policy, University at Albany, Albany, NY, United States of America
| | - Heeun Kim
- Department of Public Administration and Policy, Rockefeller College of Public Affairs and Policy, University at Albany, Albany, NY, United States of America
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11
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Hamill MM, Hu F, Adebajo S, Kokogho A, Tiamiyu AB, Parker ZF, Charurat ME, Ake JA, Baral SD, Nowak RG, Crowell TA. Food and Water Insecurity in Sexual and Gender Minority Groups Living With HIV in Lagos, Nigeria. J Acquir Immune Defic Syndr 2023; 93:171-180. [PMID: 36881816 PMCID: PMC10293107 DOI: 10.1097/qai.0000000000003183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Food and water insecurity are associated with poor health outcomes that may be exacerbated by social marginalization and barriers to health care experienced by sexual and gender minorities (SGM) in resource-limited settings. We explored factors associated with food and water insecurity in SGM with HIV. SETTING A longitudinal study of 357 men who have sex with men, transgender women, and other gender-identifying people in Lagos, Nigeria. METHODS Laboratory testing, interviews, food and water assessments, and anthropometry were performed quarterly. Robust Poisson regression with generalized estimating equations was used to evaluate factors potentially associated with food and water insecurity. RESULTS From 2014 to 2018, 357 SGM with HIV completed either the food or water assessments. At baseline, participants identified as cisgender men who have sex with men 265 (74.2%), transgender women 63 (17.7%), or as nonbinary/other gender 29 (8.1%). Food insecurity and water insecurity were reported by 63/344(18.3%) and 113/357(31.7%), respectively, at any visit. Food and water insecurity each decreased with ongoing study participation. Food insecurity was associated with nonpartnered relationship status, CD4 count <500 cells/mm 3 , and lack of access to piped water. Water insecurity was associated with age 25 years or older, living with a man, transactional sex, and food insecurity. CONCLUSIONS Food and water insecurity were common among SGM in Nigeria and decreased with continued study participation, suggesting amenability to intervention when SGM are successfully engaged in care. Targeted interventions to support food and water security may improve HIV-related outcomes, such as CD4 count.
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Affiliation(s)
- Matthew M. Hamill
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, USA
| | - Fengming Hu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
| | - Sylvia Adebajo
- Maryland Global Initiatives Corporation, University of Maryland Baltimore, Baltimore, USA
| | - Afoke Kokogho
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
| | - Abdulwasiu B. Tiamiyu
- HJF Medical Research International, Abuja, Nigeria
- US Army Medical Research Directorate-Africa/Nigeria, Abuja, Nigeria
| | - Zahra F. Parker
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
- US Army Medical Research Directorate-Africa/Nigeria, Abuja, Nigeria
| | - Manhattan E. Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Julie A. Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
| | - Stefan D. Baral
- Department of Epidemiology, Johns Hopkins University, Baltimore, USA
| | - Rebecca G. Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Trevor A. Crowell
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, USA
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
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12
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Cinque F, Cespiati A, Lombardi R, Guaraldi G, Sebastiani G. Nutritional and Lifestyle Therapy for NAFLD in People with HIV. Nutrients 2023; 15:nu15081990. [PMID: 37111209 PMCID: PMC10140991 DOI: 10.3390/nu15081990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
HIV infection and nonalcoholic fatty liver disease (NAFLD) are two major epidemics affecting millions of people worldwide. As people with HIV (PWH) age, there is an increased prevalence of metabolic comorbidities, along with unique HIV factors, such as HIV chronic inflammation and life-long exposure to antiretroviral therapy, which leads to a high prevalence of NAFLD. An unhealthy lifestyle, with a high dietary intake of refined carbohydrates, saturated fatty acids, fructose added beverages, and processed red meat, as well as physical inactivity, are known to trigger and promote the progression of NAFLD to nonalcoholic steatohepatitis, liver fibrosis, and hepatocellular carcinoma. Furthermore, with no currently approved pharmacotherapy and a lack of clinical trials that are inclusive of HIV, nutritional and lifestyle approaches still represent the most recommended treatments for PWH with NAFLD. While sharing common features with the general population, NAFLD in PWH displays its own peculiarities that may also reflect different impacts of nutrition and exercise on its onset and treatment. Therefore, in this narrative review, we aimed to explore the role of nutrients in the development of NAFLD in PWH. In addition, we discussed the nutritional and lifestyle approaches to managing NAFLD in the setting of HIV, with insights into the role of gut microbiota and lean NAFLD.
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Affiliation(s)
- Felice Cinque
- Division of Gastroenterology and Hepatology, and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
- Medicine and Metabolic Disease Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Annalisa Cespiati
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
- Medicine and Metabolic Disease Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Rosa Lombardi
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
- Medicine and Metabolic Disease Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
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13
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Wheatley MM, White KM, Peterson AD, Hanft J, Rowles D, Blissett T, Enns EA. Barriers, opportunities, and potential costs of expanding HIV support services. AIDS Care 2023:1-8. [PMID: 36803053 DOI: 10.1080/09540121.2023.2179593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Experiencing housing instability, food insecurity, and financial stress can negatively impact retention in care and treatment adherence for people living with HIV. Expanding services that support socioeconomic needs could help improve HIV outcomes. Our objective was to investigate barriers, opportunities, and costs of expanding socioeconomic support programs. Semi-structured interviews were conducted with organizations serving U.S. Ryan White HIV/AIDS Program clients. Costs were estimated from interviews, organization documents, and city-specific wages. Organizations reported complex patient, organization, program, and system challenges as well as several opportunities for expansion. The average one-year per-person cost for engaging new clients was $196 for transportation, $612 for financial aid, $650 for food aid, and $2498 for short-term housing (2020 USD). Understanding potential expansion costs is important for funders and local stakeholders. This study provides a sense of magnitude for costs to scale-up programs to better meet socioeconomic needs of low-income patients living with HIV.
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Affiliation(s)
- Margo M Wheatley
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Katie M White
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | | | | | - Darin Rowles
- Minnesota Department of Human Services, St. Paul, MN, USA
| | | | - Eva A Enns
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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14
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Stecher C, Palimaru AI, Odiit M, Lunkuse L, Walukaga S, Linnemayr S. Barriers and facilitators of antiretroviral therapy (ART) adherence habit formation in Sub-Saharan Africa: Evidence from a qualitative study in Kampala, Uganda. Soc Sci Med 2023; 317:115567. [PMID: 36459789 PMCID: PMC9839633 DOI: 10.1016/j.socscimed.2022.115567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 10/12/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022]
Abstract
RATIONALE In 2020, nearly 40 million people lived with HIV/AIDS (PLWHA) worldwide, of whom 70% were receiving antiretroviral therapy (ART). Two-thirds of PLWHA reside in Sub-Saharan Africa (SSA), where rates of viral load suppression are often suboptimal and frequently attributed to low ART adherence. Strong pill-taking habits are often reported as a key strategy among those who successfully maintain medication adherence, yet not enough is known about the barriers and facilitators in SSA to pill-taking in response to the same contextual cue, which is a necessary step in the habit formation process. OBJECTIVE To address this knowledge gap and to inform a subsequent intervention to promote context-dependent repetition, called anchoring, we used a formative qualitative approach to collect in-depth narratives about barriers and facilitators of the anchoring intervention for establishing ART pill-taking habits at the Mildmay Hospital in Kampala, Uganda. METHODS We conducted interviews with 25 randomly selected patients starting ART, 5 expert patients, and 10 providers at Mildmay, and performed a rapid analysis to inform the intervention in a timely manner. RESULTS We found that pill taking in response to the same contextual cue, or anchor, was threatened by stigma and food insecurity and that the COVID-19 pandemic exacerbated these barriers. We also determined that important linguistic changes were needed to the instructional materials and reminder messages in the subsequent intervention to avoid words and phrases with negative connotations for this target population. CONCLUSIONS Several important barriers and facilitators to context-dependent pill taking in Uganda were identified through our formative research that helped to inform important revisions to our subsequent intervention. These findings underscore the importance of understanding local barriers and facilitators when designing and planning interventions, particularly when implementing theory-based intervention approaches that have yet to be tested in a new setting.
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Affiliation(s)
- Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
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15
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Kalichman SC. Ending HIV Hinges on Reducing Poverty. AIDS Behav 2023; 27:1-3. [PMID: 35794431 DOI: 10.1007/s10461-022-03766-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 06269, 2006 Hillside Road, Storrs, CT, USA.
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16
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Prall S, Scelza B. The dietary impacts of drought in a traditional pastoralist economy. Am J Hum Biol 2023; 35:e23803. [PMID: 36125188 DOI: 10.1002/ajhb.23803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/11/2022] [Accepted: 09/02/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Arid pastoralism is often understood as an adaptive strategy to marginal environments. As pastoralists become increasingly market integrated, novel dietary preferences and access to low quality market foods can erode traditional diets. These market-based dietary shifts are particularly problematic during sustained drought, where reductions in traditional foods make pastoralists increasingly reliant on a cash economy. Among the Himba of the Kunene region in Namibia, colonial policies prohibiting access to livestock markets inhibit access to a cash-based economy, leaving them vulnerable to food insecurity when nontraditional foods are needed to supplement traditional lifeways during drought. To understand the impacts of long-term drought on diet and food insecurity, we collected longitudinal survey data on diet breadth and food insecurity across 4 years during a multi-year drought. METHODS Participants completed a five-item food insecurity survey and recalled diet breadth survey over the course of 4 years (N = 191-234). Additionally, women completed a short survey of recent stressors, including health and resource stressors (N = 127). We used a set of multilevel models to estimate changes in food insecurity items and diet breadth changes over the course of the study period. RESULTS Multilevel models predicted score outcomes, as well as individual item responses, by year of data collection. Results indicate a 43% increase in average food insecurity and a 15% decline in average diet breadth over the study period. Dietary recall indicates that drought caused a reduction in sour milk intake, and an increase in nontraditional foods, but no change in meat or maize consumption. CONCLUSIONS Sustained drought in the Kunene region is having long-term impacts on food insecurity, which could result in dietary shifts that outlast the current period of drought. We consider the implications of this change, especially as it relates to increasing market integration and reliance on a cash-based over a subsistence-based economy.
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Affiliation(s)
- Sean Prall
- Department of Anthropology, University of Missouri, Columbia, Missouri, USA
| | - Brooke Scelza
- Department of Anthropology, University of California, Los Angeles, California, USA
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17
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Traynor SM, Schmidt RD, Gooden LK, Matheson T, Haynes L, Rodriguez A, Mugavero M, Jacobs P, Mandler R, Del Rio C, Carrico AW, Horigian VE, Metsch LR, Feaster DJ. Differential Effects of Patient Navigation across Latent Profiles of Barriers to Care among People Living with HIV and Comorbid Conditions. J Clin Med 2022; 12:114. [PMID: 36614917 PMCID: PMC9820894 DOI: 10.3390/jcm12010114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/29/2022] [Accepted: 12/10/2022] [Indexed: 12/28/2022] Open
Abstract
Engaging people living with HIV who report substance use (PLWH-SU) in care is essential to HIV medical management and prevention of new HIV infections. Factors associated with poor engagement in HIV care include a combination of syndemic psychosocial factors, mental and physical comorbidities, and structural barriers to healthcare utilization. Patient navigation (PN) is designed to reduce barriers to care, but its effectiveness among PLWH-SU remains unclear. We analyzed data from NIDA Clinical Trials Network's CTN-0049, a three-arm randomized controlled trial testing the effect of a 6-month PN with and without contingency management (CM), on engagement in HIV care and viral suppression among PLWH-SU (n = 801). Latent profile analysis was used to identify subgroups of individuals' experiences to 23 barriers to care. The effects of PN on engagement in care and viral suppression were compared across latent profiles. Three latent profiles of barriers to care were identified. The results revealed that PN interventions are likely to be most effective for PLWH-SU with fewer, less severe healthcare barriers. Special attention should be given to individuals with a history of abuse, intimate partner violence, and discrimination, as they may be less likely to benefit from PN alone and require additional interventions.
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Affiliation(s)
- Sharleen M. Traynor
- Clinical Trials Research Associate Program, Durham Technical Community College, Durham, NC 27703, USA
| | - Renae D. Schmidt
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
| | - Lauren K. Gooden
- Sociomedical Sciences Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Tim Matheson
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA 94102, USA
| | - Louise Haynes
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Allan Rodriguez
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Michael Mugavero
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Blvd # 229, Birmingham, AL 35233, USA
| | - Petra Jacobs
- Center for Clinical Trials Network, National Institute on Drug Abuse, Rockville, MD 20892, USA
| | - Raul Mandler
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA
| | - Carlos Del Rio
- Division of Infectious Diseases, Emory University, Atlanta, GA 30322, USA
| | - Adam W. Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
| | - Viviana E. Horigian
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
| | - Lisa R. Metsch
- Sociomedical Sciences Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
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Tarfa A, Pecanac K, Shiyanbola OO. A qualitative inquiry into the patient-related barriers to linkage and retention in HIV care within the community setting. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 9:100207. [PMID: 36568895 PMCID: PMC9772845 DOI: 10.1016/j.rcsop.2022.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/07/2022] Open
Abstract
Background People with the Human Immunodeficiency Virus (PWH) experience barriers to care within the community that impedes their progress from when they discover that they are HIV positive to becoming virally suppressed. For individuals with HIV to achieve sustained viral suppression, they must be linked to care to start receiving anti-retroviral therapy and remain retained in care for continuous treatment. However, HIV surveillance data shows that many PWH are not linked to care and become lost to continuous follow-up care. Although pharmacists, PWH, and social workers interact with one another and are aware of their roles in HIV care, their perspectives on barriers to linkage and retention in care have not been investigated collectively. Objectives Explore the perspectives of PWH, pharmacists, and social workers on barriers to linkage and retention of HIV care within the community setting. Methods Convenience sampling was used to recruit 15 stakeholders (five PWH, five community pharmacists, and five social workers) who participated in 1-h, semi-structured interviews based on three domains of the Patient-centered Medical Home Model including (1) experiences (individual and system-level barriers to care experienced by PWH), (2) activities (social workers and pharmacists initiatives that impact adherence to care)and (3) interventions (critical issues pharmacists can address in the community to engage PWH in their HIV care). We conducted a directed content analysis based on deductive coding. To establish rigor, we focused on Lincoln and Guba's criteria of rigorous qualitative methodology: credibility, dependability, confirmability, and transferability. Similarities and divergences of themes were discussed during data analysis and agreement was reached before interpretation. Results Emergent themes uncovered barriers to linkage and retention in HIV care as HIV-related stigma, having mental health illnesses including a history of substance abuse and social determinants of health such as homelessness, food insecurity, and insurance issues. Conclusion The perspectives of pharmacists, social workers, and PWH can provide insight into barriers that should be identified and addressed in people living with HIV to enhance their linkage and retention in care.
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Affiliation(s)
- Adati Tarfa
- 2506 Rennebohm Hall, School of Pharmacy, University of Wisconsin, 777 Highland Ave., Madison, WI 53705-222, United States of America,Corresponding author.
| | - Kristen Pecanac
- 4167 Signe Skott Cooper Hall, University of Wisconsin, 701 Highland Avenue, Madison, WI 53705, United States of America
| | - Olayinka O. Shiyanbola
- 2517 Rennebohm Hall, School of Pharmacy, University of Wisconsin, 777 Highland Ave., Madison, WI 53705-222, United States of America
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19
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Dreyer AJ, Nightingale S, Andersen LS, Lee JS, Gouse H, Safren SA, O'Cleirigh C, Thomas KGF, Joska J. Cognitive performance in a South African cohort of people with HIV and comorbid major depressive disorder. J Neurovirol 2022; 28:537-551. [PMID: 36048403 PMCID: PMC10471884 DOI: 10.1007/s13365-022-01093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/22/2022] [Accepted: 08/10/2022] [Indexed: 01/13/2023]
Abstract
Cognitive performance in people with HIV (PWH) may be affected by brain injury attributable to the infection itself, by other medical and psychiatric comorbidities (including major depressive disorder; MDD), and by psychosocial factors (e.g., education, food insecurity). We investigated effects of these variables on cognitive performance in a South African cohort of PWH with comorbid MDD and incomplete adherence to antiretroviral therapy (ART). We also examined (a) associations of depression severity with cognitive performance, and (b) whether improvement in depression led to improved cognitive performance. Participants (N = 105) completed baseline neuropsychological, psychiatric, and sociodemographic assessments. Subsequently, 33 were assigned to a cognitive-behavioural therapy for ART adherence and depression (CBT-AD) and 72 to standard-of-care treatment. Eight months post-baseline, 81 (nCBT-AD = 29) repeated the assessments. We investigated (a) baseline associations between sociodemographic, medical, and psychiatric variables and cognitive performance, (b) whether, from baseline to follow-up, depression and cognitive performance improved significantly more in CBT-AD participants, and (c) associations between post-intervention improvements in depression and cognitive performance. At baseline, less education (β = 0.62) and greater food insecurity (β = -0.20) predicted poorer overall cognitive performance; more severe depression predicted impairment in the attention/working memory domain only (β = -0.25). From baseline to follow-up, depression decreased significantly more in CBT-AD participants (p = .017). Improvement over time in depression and cognitive performance was not significantly associated except in the attention/working memory domain (p = .026). Overall, factors associated with cognitive performance were unrelated to brain injury. We conclude that clinicians examining PWH presenting with cognitive difficulties must assess depression, and that researchers investigating cognitive impairment in PWH must collect information on psychosocial factors.
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Affiliation(s)
- Anna J Dreyer
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
| | - Sam Nightingale
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Lena S Andersen
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Jasper S Lee
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Hetta Gouse
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Conall O'Cleirigh
- Department of Psychology, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin G F Thomas
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT), Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - John Joska
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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20
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Jarolimova J, Yan J, Govere S, Bunda BA, Wara NJ, Bogart LM, Ngobese N, Shazi ZM, Khumalo AR, Zionts D, Thulare H, Parker RA, Bassett IV. Experiences of participants in a decentralized antiretroviral therapy program in South Africa during the COVID-19 pandemic. AIDS Care 2022; 34:1413-1419. [PMID: 35877987 PMCID: PMC9873830 DOI: 10.1080/09540121.2022.2095333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/23/2022] [Indexed: 01/27/2023]
Abstract
The COVID-19 pandemic and associated restrictions could adversely affect long-term HIV care. We evaluated the experiences of people receiving antiretroviral therapy (ART) through a decentralized delivery program in South Africa during the COVID-19 pandemic. We telephoned a random subsample of participants enrolled in a prospective cohort study in KwaZulu-Natal in April and May 2020 and administered a semi-structured telephone interview to consenting participants. We completed interviews with 303 of 638 contacted participants (47%); 66% were female, with median age 36y. The most common concerns regarding the COVID-19 pandemic were food running out (121, 40%), fear of becoming infected with COVID-19 (103, 34%), and being unable to work/losing employment or income (102, 34%). Twenty-five (8%) participants had delayed ART pick-up due to the pandemic, while 212 (70%) had new concerns about ART access going forward. Mental health scores were worse during the pandemic compared to baseline (median score 65.0 vs 80.0, p < 0.001). Decentralized ART distribution systems have the potential to support patients outside of health facilities during the COVID-19 pandemic, but economic concerns and mental health impacts related to the pandemic must also be recognized and addressed.
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Affiliation(s)
- Jana Jarolimova
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, United States
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, United States
| | - Joyce Yan
- Massachusetts General Hospital, Biostatistics Center, Boston, United States
| | | | - Bridget A Bunda
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, United States
| | - Nafisa J Wara
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, United States
| | | | | | | | | | - Dani Zionts
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, United States
| | | | - Robert A Parker
- Massachusetts General Hospital, Biostatistics Center, Boston, United States
- Harvard University, Center for AIDS Research (CFAR), Boston, United States
- Harvard Medical School, Boston, United States
| | - Ingrid V Bassett
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, United States
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, United States
- Harvard University, Center for AIDS Research (CFAR), Boston, United States
- Harvard Medical School, Boston, United States
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21
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Zlotorzynska M, Sanchez T. Food insecurity as a social determinant of sexual health and substance use independent of poverty status among men who have sex with men in the United States. Ann Epidemiol 2022; 74:97-103. [PMID: 35788033 DOI: 10.1016/j.annepidem.2022.06.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 06/17/2022] [Accepted: 06/22/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To characterize the prevalence of food insecurity among men who have sex with men (MSM) and assess its associations with sexual health measures and substance use, as compared to poverty status. METHODS In 2017, 10,049 US MSM were recruited online and completed the American Men's Internet Survey. The survey assessed food insecurity, annual household income and past-year behaviors: condomless anal intercourse (CAI), exchange sex, any illicit substance use other than marijuana, use of methamphetamine, alkyl nitrites or gamma-hydroxybutyrate (GHB), HIV testing and sexually transmitted infection testing and diagnosis. We tested associations between behavioral outcomes and food insecurity or poverty, controlling for demographic characteristics. RESULTS The prevalence of food insecurity among AMIS participants was 15.8%. Food insecurity non-response was 2.5% while income non-response was 19.0%. Food insecurity was significantly and positively associated with all behavioral outcomes, while poverty was significantly and positively associated only with exchange sex, any illicit substance use, methamphetamine and GHB use. In models that included both food insecurity and poverty as exposures, food insecurity remained independently positively associated with all behavioral outcomes and the associations for poverty level were null for all outcomes except methamphetamine and GHB use. CONCLUSIONS Assessing food insecurity in sexual health and substance use survey research may provide a more robust indicator of economic deprivation and provide insight for HIV and STI prevention interventions.
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Affiliation(s)
- Maria Zlotorzynska
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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22
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Reddon H, Socias ME, Justice A, Cui Z, Nosova E, Barrios R, Fairbairn N, Marshall BDL, Milloy MJ. Periods of Homelessness Linked to Higher VACS Index Among HIV-Positive People Who Use Drugs. AIDS Behav 2022; 26:1739-1749. [PMID: 35064852 PMCID: PMC9150923 DOI: 10.1007/s10461-021-03524-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/26/2022]
Abstract
We sought to evaluate the impact of homelessness on HIV disease progression among people who use unregulated drugs (PWUD) living with HIV and test if this association was mediated by adherence to antiretroviral therapy (ART). We applied general linear mixed-effects modeling to estimate the longitudinal relationship between homelessness and the Veterans Aging Cohort Study (VACS) Index, a validated measure of HIV disease progression that predicts all-cause mortality, among a prospective cohort of PWUD. In a longitudinal model adjusted for ART adherence, homelessness was significantly associated with increased VACS Index scores and 16% of the association was mediated by ART adherence. These findings indicate that homelessness was a significant risk factor for HIV disease progression and this association was marginally mediated by ART adherence. Future studies are needed to quantify the other mechanisms (e.g., food insecurity, mental health) by which homelessness increases mortality risk among PWUD living with HIV.
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Affiliation(s)
- Hudson Reddon
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Division of Social Medicine, Department of Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Division of Social Medicine, Department of Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Amy Justice
- Department of Medicine, Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA
| | - Zishan Cui
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Division of Social Medicine, Department of Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Ekaterina Nosova
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Division of Social Medicine, Department of Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI, 02912, USA
| | - M-J Milloy
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- Division of Social Medicine, Department of Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
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Guinto RR, Cahatol JJF, Lazaro KYMS, Salazar AFNC. Pathways linking climate change and HIV/AIDS: An updated conceptual framework and implications for the Philippines. THE JOURNAL OF CLIMATE CHANGE AND HEALTH 2022; 6:100106. [PMID: 35945919 PMCID: PMC9352190 DOI: 10.1016/j.joclim.2021.100106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/19/2021] [Indexed: 06/15/2023]
Abstract
As we commemorate the 40th anniversary of the discovery of Human Immunodeficiency Virus (HIV) while fighting the ongoing COVID-19 pandemic, another global crisis - climate change - is threatening the progress achieved so far in the global fight against HIV/AIDS. The climate emergency is anticipated to generate dire health consequences worldwide in the coming decades. While the pathways that link climate change and different disease areas are better understood, the connection between climate change and HIV/AIDS is still yet to be recognized both in research and practice. In this review, we update one of the frameworks on the HIV-climate nexus described in earlier literature. Four major pathways have been identified: extreme weather events; sea level rise; changes in precipitation and temperature; and increased air pollution. These pathways impact the spectrum of HIV/AIDS-related outcomes through changes in social systems, healthcare disruption, and other climate-sensitive diseases, influenced by the social determinants of health. We also reflect on the significance of this updated framework for the Philippines, a country that is both highly vulnerable to the climate crisis and facing a rising HIV/AIDS epidemic. The framework can aid countries like the Philippines in filling gaps in research, policy, and program design to mount climate-adaptive HIV/AIDS responses. The HIV/AIDS and climate justice movements must also join forces in calling for accelerated worldwide decline in greenhouse gas emissions from all sectors to stabilize the global climate - this will benefit not just people affected by HIV/AIDS but everyone.
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Affiliation(s)
- Renzo R Guinto
- St. Luke's Medical Center College of Medicine-William H. Quasha Memorial, Quezon City, Philippines
- Sunway Centre for Planetary Health, Sunway University, Selangor, Malaysia
- PH Lab, Manila, Philippines
- Planetary Health Philippines, Manila, Philippines
| | - Joshua Joel F Cahatol
- St. Luke's Medical Center College of Medicine-William H. Quasha Memorial, Quezon City, Philippines
| | - Kris Yvan Mari S Lazaro
- St. Luke's Medical Center College of Medicine-William H. Quasha Memorial, Quezon City, Philippines
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McMahan LD, Lombe M, Evans CBR, Enelamah NV, Chu Y, Simms S, Verkamp-Ruthven J, Martinez JR, Mweemba O, LaForest L, Weiss DJ, Wideman L. Getting to zero HIV/AIDS in sub-Saharan Africa: Understanding perceptions of locals using the social determinants of health framework. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e739-e748. [PMID: 34028915 DOI: 10.1111/hsc.13444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/20/2021] [Accepted: 05/04/2021] [Indexed: 06/12/2023]
Abstract
This study explored a community perception of the facilitators and inhibitors of Getting to Zero (GTZ) in rural Zambia, sub-Saharan Africa. Data were collected in 2017. We use the Social Determinants of Health framework to guide organisation of key themes emerging from semistructured, focus group interviews with community members (N = 52). Data were analysed through an iterative descriptive/thematic approach which allowed for the highlighting of key themes. Emerging themes point to the significance of (a) individual, (b) sociocultural, (c) environmental and (d) economic factors, for example, treatment adherence, gender norms, food security and access to health care as important in GTZ. Implications for policy, practise and scholarship are suggested.
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Affiliation(s)
- Lyndsey D McMahan
- School of Social Work, Boston College, Chestnut Hill, MA, USA
- Department of Conflict Resolution, Human Security & Global Governance, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Margaret Lombe
- School of Social Work, Boston College, Chestnut Hill, MA, USA
| | | | | | - Yoosun Chu
- Department of Social Welfare, Keimyung University, Daegu, South Korea
| | | | | | | | | | | | | | - Laura Wideman
- Department of Psychology, North Carolina State University, Raleigh, NC, USA
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Prevalence and predictors of food insecurity among people living with and without HIV in the African Cohort Study. Public Health Nutr 2022; 25:930-943. [PMID: 34420547 PMCID: PMC9991625 DOI: 10.1017/s136898002100361x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We determined the prevalence and identified predictors of food insecurity in four African countries. DESIGN Cross-sectional analyses at study enrolment. SETTING From January 2013 to March 2020, people living with HIV (PLWH) and without HIV were enrolled at twelve clinics in Kenya, Uganda, Tanzania and Nigeria. PARTICIPANTS Participants reporting not having enough food to eat over the past 12 months or receiving <3 meals/d were defined as food insecure. Robust Poisson regression models were used to estimate unadjusted and adjusted prevalence ratios (aPR) and 95 % CI for predictors of food insecurity among all participants and separately among PLWH. RESULTS 1694/3496 participants (48·5 %) reported food insecurity at enrolment, with no difference by HIV status. Food insecurity was more common among older participants (50+ v. 18-24 years aPR 1·35, 95 % CI 1·15, 1·59). Having 2-5 (aPR 1·14, 95 % CI 1·01, 1·30) or >5 dependents (aPR 1·17, 95 % CI 1·02, 1·35), and residing in Kisumu West, Kenya (aPR 1·63, 95 % CI 1·42, 1·87) or Nigeria (aPR 1·20, 95 % CI 1·01, 1·41) was associated with food insecurity. Residing in Tanzania (aPR 0·65, 95 % CI 0·53, 0·80) and increasing education (secondary/above education v. none/some primary education aPR 0·73, 95 % CI 0·66, 0·81) was protective against food insecurity. Antiretroviral therapy (ART)-experienced PLWH were more likely to be food secure irrespective of viral load. CONCLUSION Food insecurity was highly prevalent in our cohort though not significantly associated with HIV. Policies aimed at promoting education, elderly care, ART access in PLWH and financial independence could potentially improve food security in Africa.
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Nagata JM, Miller JD, Cohen CR, Frongillo EA, Weke E, Burger R, Wekesa P, Sheira LA, Mocello AR, Otieno P, Butler LM, Bukusi EA, Weiser SD, Young SL. Water Insecurity is Associated with Lack of Viral Suppression and Greater Odds of AIDS-Defining Illnesses Among Adults with HIV in Western Kenya. AIDS Behav 2022; 26:549-555. [PMID: 34373987 PMCID: PMC8813828 DOI: 10.1007/s10461-021-03410-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 12/21/2022]
Abstract
Reliable access to safe and acceptable water in sufficient quantities (i.e., water security) is important for medication adherence and limiting pathogen exposure, yet prior studies have only considered the role of food security as a social determinant of HIV-related health. Therefore, the objective of this analysis was to assess the relationships between household water insecurity and HIV-related outcomes among adults living with HIV in western Kenya (N = 716). We conducted a cross-sectional analysis of baseline data from Shamba Maisha (NCT02815579), a cluster randomized controlled trial of a multisectoral agricultural and asset loan intervention. Baseline data were collected from June 2016 to December 2017. We assessed associations between water insecurity and HIV-related outcomes, adjusting for clinical and behavioral confounders, including food insecurity. Each five-unit higher household water insecurity score (range: 0-51) was associated with 1.21 higher odds of having a viral load ≥ 1000 copies/mL (95% CI 1.07, 1.36) and 1.26 higher odds of AIDS-defining illness (95% CI 1.11, 1.42). Household water insecurity was not associated with CD4 cell count (B: 0.27; 95% CI -3.59, 13.05). HIV treatment and support programs should consider assessing and addressing water insecurity in addition to food insecurity to optimize HIV outcomes.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, 550 16th Street, Box 0110, San Francisco, CA, 94158, USA.
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA.
| | - Joshua D Miller
- Department of Nutrition, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rachel Burger
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lila A Sheira
- Department of Medicine, University of California, San Francisco, CA, USA
| | - A Rain Mocello
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Phelgona Otieno
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lisa M Butler
- Institute for Collaboration On Health, Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Elizabeth A Bukusi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
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Peprah E, Myers B, Kengne AP, Peer N, El-Shahawy O, Ojo T, Mukasa B, Ezechi O, Iwelunmor J, Ryan N, Sakho F, Patena J, Gyamfi J. Using a Syndemics Framework to Understand How Substance Use Contributes to Morbidity and Mortality among People Living with HIV in Africa: A Call to Action. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031097. [PMID: 35162121 PMCID: PMC8834153 DOI: 10.3390/ijerph19031097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 02/04/2023]
Abstract
Substance use is increasing throughout Africa, with the prevalence of alcohol, tobacco, cannabis, and other substance use varying regionally. Concurrently, sub-Saharan Africa bears the world’s largest HIV burden, with 71% of people living with HIV (PWH) living in Africa. Problematic alcohol, tobacco, and other substance use among PWH is associated with multiple vulnerabilities comprising complex behavioral, physiological, and psychological pathways that include high-risk behaviors (e.g., sexual risk-taking), HIV disease progression, and mental health problems, all of which contribute to nonadherence to antiretroviral therapy. Physiologically, severe substance use disorders are associated with increased levels of biological markers of inflammation; these, in turn, are linked to increased mortality among PWH. The biological mechanisms that underlie the increased risk of substance use among PWH remain unclear. Moreover, the biobehavioral mechanisms by which substance use contributes to adverse health outcomes are understudied in low- and middle-income countries (LMIC). Syndemic approaches to understanding the co-occurrence of substance use and HIV have largely been limited to high-income countries. We propose a syndemic coupling conceptual model to disentangle substance use from vulnerabilities to elucidate underlying disease risk for PWH. This interventionist perspective enables assessment of biobehavioral mechanisms and identifies malleable targets of intervention.
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Affiliation(s)
- Emmanuel Peprah
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
- Correspondence:
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia;
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7925, South Africa
| | - Andre-Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; (A.-P.K.); (N.P.)
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; (A.-P.K.); (N.P.)
| | - Omar El-Shahawy
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
- Center for the Prevention of Heart Disease, John Hopkins Hospital, Baltimore, MD 21287, USA
| | - Temitope Ojo
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
| | | | - Oliver Ezechi
- Nigerian Institute of Medical Research, Yaba, Lagos 101245, Nigeria;
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Department of Behavioral Science and Health Education, Saint Louis University, St. Louis, MO 63104, USA;
| | - Nessa Ryan
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
| | - Fatoumata Sakho
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
| | - John Patena
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
| | - Joyce Gyamfi
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
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Ojo T, Ruan C, Hameed T, Malburg C, Thunga S, Smith J, Vieira D, Snyder A, Tampubolon SJ, Gyamfi J, Ryan N, Lim S, Santacatterina M, Peprah E. HIV, Tuberculosis, and Food Insecurity in Africa—A Syndemics-Based Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031101. [PMID: 35162131 PMCID: PMC8834641 DOI: 10.3390/ijerph19031101] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/16/2022] [Accepted: 01/16/2022] [Indexed: 12/13/2022]
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.
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Affiliation(s)
- Temitope Ojo
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
- Correspondence: ; Tel.: +1-203-690-9449
| | - Christina Ruan
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
| | - Tania Hameed
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
| | - Carly Malburg
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
| | - Sukruthi Thunga
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
| | - Jaimie Smith
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
| | - Dorice Vieira
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
- NYU Health Sciences Library, 550 First Avenue, New York, NY 10016, USA
| | - Anya Snyder
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
| | - Siphra Jane Tampubolon
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
| | - Joyce Gyamfi
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
| | - Nessa Ryan
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
| | - Sahnah Lim
- Section for Health Equity, Department of Population Health, NYU Langone Health, 180 Madison Avenue, New York, NY 10016, USA;
| | - Michele Santacatterina
- Division of Biostatistics, Department of Population Health, NYU Langone Health, 180 Madison Avenue, New York, NY 10016, USA;
| | - Emmanuel Peprah
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
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Sernick A, Shannon K, Ranville F, Arora K, Magagula P, Shoveller J, Krüsi A. In the midst of plenty: Experiences of food insecurity amongst women living with HIV in Vancouver, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e138-e147. [PMID: 33978282 PMCID: PMC8586035 DOI: 10.1111/hsc.13420] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 02/18/2021] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
Globally, people living with HIV (PLWH) are disproportionately affected by food insecurity. Yet there is limited understanding of the impacts of food insecurity among cisgender and transgender women living with HIV (WLWH) in high-income countries. Thus, it is critical to examine the lived experiences of WLWH and food insecurity to inform policy and service provision. As part of the community-based SHAWNA (Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment) study, we conducted 64 semistructured qualitative interviews with WLWH in Vancouver, Canada (2015-2017). Drawing on a socio-ecological framework, this analysis explores the lived experiences of navigating food security and health among WLWH in Metro Vancouver. Our findings indicate that WLWH relied heavily on food banks and other food-related supportive services. Despite the abundance of programs, access to nutritious foods remained difficult, and women often relied on processed foods that were more affordable and readily available. For many, food insecurity was exacerbated by unresponsive food services regulations that did not reflect the actual needs of food service users in terms of opening hours and locations, and a lack of nutritious food. Additionally, the absence of trauma-aware, women-centred and culturally responsive services, as well as, spatial and material barriers related to the recent loss of funding for HIV-specific support services, impeded food security among WLWH. Our findings emphasise that recognizing and addressing the social and structural disparities that exist for WLWH in high-income setting are essential for addressing food insecurity and ultimately optimal health among this population.
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Affiliation(s)
- Ariel Sernick
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Flo Ranville
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Kamal Arora
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Patience Magagula
- Afro-Canadian Positive Network of British Columbia, Surrey, British Columbia, Canada
| | - Jean Shoveller
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Izaak Walton Killam Health Centre, Halifax, Nova Scotia, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Assessment of dietary diversity and nutritional support for children living with HIV in the IeDEA pediatric West African cohort: a non-comparative, feasibility study. BMC Nutr 2021; 7:83. [PMID: 34903301 PMCID: PMC8670202 DOI: 10.1186/s40795-021-00486-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 11/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background Nutritional care is not optimally integrated into pediatric HIV care in sub-Saharan Africa. We assessed the 6-month effect of a nutritional support provided to children living with HIV, followed in a multicentric cohort in West Africa. Methods In 2014-2016, a nutritional intervention was carried out for children living with HIV, aged under 10 years, receiving antiretroviral therapy (ART) or not, in five HIV pediatric cohorts, in Benin, Togo and Côte d’Ivoire. Weight deficiency was assessed using two definitions: wasting (Weight for Height Z-score [WHZ] for children<5 years old or Body-Mass-Index for Age [BAZ] for ≥5 years) and underweight (Weight for Age Z-score [WAZ]) (WHO child growth standards). Combining these indicators, three categories of nutritional support were defined: 1/ children with severe malnutrition (WAZ and/or WHZ/BAZ <-3 Standard Deviations [SD]) were supported with Ready-To-Use Therapeutic Food (RUTF), 2/ those with moderate malnutrition (WAZ and/or WHZ/BAZ = [-3;-2[ SD) were supported with fortified blended flours produced locally in each country, 3/ those non malnourished (WAZ and WHZ/BAZ ≥-2 SD) received nutritional counselling only. Children were followed monthly over 6 months. Dietary Diversity Score (DDS) using a 24h recall was measured at the first and last visit of the intervention. Results Overall, 326 children were included, 48% were girls. At baseline, 66% were aged 5-10 years, 91% were on ART, and 17% were severely immunodeficient (CD4 <250 cells/mL or CD4%<15). Twenty-nine (9%) were severely malnourished, 63 (19%) moderately malnourished and 234 (72%) non-malnourished. After 6 months, 9/29 (31%) and 31/63 (48%) recovered from severe and moderate malnutrition respectively. The median DDS was 8 (IQR 7-9) in Côte d’Ivoire and Togo, 6 (IQR 6-7) in Benin. Mean DDS was 4.3/9 (sd 1.2) at first visit, with a lower score in Benin, but with no difference between first and last visit (p=0.907), nor by intervention groups (p-value=0.767). Conclusions This intervention had a limited effect on nutritional recovery and dietary diversity improvement. Questions remain on determining appropriate nutritional products, in terms of adherence, proper use for families and adequate energy needs coverage for children living with HIV. Trial registration PACTR202001816232398, June 01, 2020, retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-021-00486-4.
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Toledo G, Côté HCF, Adler C, Thorne C, Goetghebuer T. Neurological development of children who are HIV-exposed and uninfected. Dev Med Child Neurol 2021; 63:1161-1170. [PMID: 33987826 DOI: 10.1111/dmcn.14921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 12/20/2022]
Abstract
Widespread use of antiretroviral drugs for pregnant/breastfeeding females with human immunodeficiency virus (HIV) has led to declining vertical transmission. Despite being HIV-uninfected, the increasing number of children who are HIV-exposed and uninfected (CHEU) often present with developmental alterations. We review seminal and recent evidence on the neurological development of CHEU and associations with early life HIV/antiretroviral exposure. Our conceptual model highlights the numerous exposures and universal risk factors for CHEU developmental disorders. Early studies suggest a significant association between HIV exposure and neurological abnormalities, varying according to the burden of HIV-specific exposures and other risk factors. More recent observations from the modern era are inconsistent, although some studies suggest specific antiretrovirals may adversely affect neurological development of CHEU. As the CHEU population continues to grow, alongside simultaneous increases in types and combinations of antiretrovirals used in pregnancy, long-term monitoring of CHEU is necessary for understanding the effects of HIV/antiretroviral exposure on CHEU developmental outcomes. What this paper adds Evidence on the neurological development of children who are human immunodeficiency virus (HIV)-exposed and uninfected (CHEU) is synthesized. Comparisons are made to children who are HIV-unexposed, across treatment eras and settings, and by antiretroviral drug regimens and drug classes. CHEU exposures are complex and include HIV-specific and universal risk factors which may affect development during the early years of life.
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Affiliation(s)
- Gabriela Toledo
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Hélène C F Côté
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Adler
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Claire Thorne
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Tessa Goetghebuer
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
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Pereira M, Magno L, da Silva Gonçalves L, Dourado I. HIV Infections and Food Insecurity Among Pregnant Women from Low- and Middle-Income Countries: A Systematic Review and Meta-analysis. AIDS Behav 2021; 25:3183-3193. [PMID: 33903996 PMCID: PMC8075027 DOI: 10.1007/s10461-021-03280-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 12/30/2022]
Abstract
There are few studies on the occurrence of food insecurity (FI) in pregnant women living with HIV/AIDS (PrWLWHA). Our objective was to estimate the prevalence of food insecurity among PrWLWHA and to analyse the association between HIV and FI. For this we searched eight databases. We used the prevalence and prevalence ratio (PR) with a 95% confidence interval (CI) as the summary measurements for the meta-analysis. We identified 300 studies, 13 of which were eligible. The prevalence of FI was 64%, ranging between 26% (mild), 33% (moderate) and 27% (severe). People living with HIV/AIDS (PLWHA) had a 23% greater chance of facing FI (PR = 1.23, 95% CI 1.16-1.38) compared to those not living with HIV. The results revealed a high prevalence and positive association with FI among PLWHA, which suggests the need for food security assessments in HIV/AIDS clinical care.
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Affiliation(s)
- Marcos Pereira
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador, 45760-030, Bahia, Brazil.
| | - Laio Magno
- Department of Life Sciences, Bahia State University, Rua Silveira Martins, 2555, Cabula, Salvador, Bahia, Brazil
| | - Luana da Silva Gonçalves
- Center for Biological and Health Sciences, Federal University of Western Bahia, Barreiras, Bahia, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador, 45760-030, Bahia, Brazil
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Sheira LA, Frongillo EA, Hahn J, Palar K, Riley ED, Wilson TE, Adedimeji A, Merenstein D, Cohen M, Wentz EL, Adimora AA, Ofotokun I, Metsch L, Turan JM, Tien PC, Weiser SD. Relationship between food insecurity and smoking status among women living with and at risk for HIV in the USA: a cohort study. BMJ Open 2021; 11:e054903. [PMID: 34489299 PMCID: PMC8422493 DOI: 10.1136/bmjopen-2021-054903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES People living with HIV (PLHIV) in the USA, particularly women, have a higher prevalence of food insecurity than the general population. Cigarette smoking among PLHIV is common (42%), and PLHIV are 6-13 times more likely to die from lung cancer than AIDS-related causes. This study sought to investigate the associations between food security status and smoking status and severity among a cohort of predominantly low-income women of colour living with and without HIV in the USA. DESIGN Women enrolled in an ongoing longitudinal cohort study from 2013 to 2015. SETTING Nine participating sites across the USA. PARTICIPANTS 2553 participants enrolled in the Food Insecurity Sub-Study of the Women's Interagency HIV Study, a multisite cohort study of US women living with HIV and demographically similar HIV-seronegative women. OUTCOMES Current cigarette smoking status and intensity were self-reported. We used cross-sectional and longitudinal logistic and Tobit regressions to assess associations of food security status and changes in food security status with smoking status and intensity. RESULTS The median age was 48. Most respondents were African-American/black (72%) and living with HIV (71%). Over half had annual incomes ≤US$12 000 (52%). Food insecurity (44%) and cigarette smoking (42%) were prevalent. In analyses adjusting for common sociodemographic characteristics, all categories of food insecurity were associated with greater odds of current smoking compared with food-secure women. Changes in food insecurity were also associated with increased odds of smoking. Any food insecurity was associated with higher smoking intensity. CONCLUSIONS Food insecurity over time was associated with smoking in this cohort of predominantly low-income women of colour living with or at risk of HIV. Integrating alleviation of food insecurity into smoking cessation programmes may be an effective method to reduce the smoking prevalence and disproportionate lung cancer mortality rate particularly among PLHIV.
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Affiliation(s)
- Lila A Sheira
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina System, Columbia, South Carolina, USA
| | - Judith Hahn
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - Kartika Palar
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - Elise D Riley
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - Tracey E Wilson
- Community Health Sciences, School of Public Health, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel Merenstein
- Family Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Mardge Cohen
- Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Eryka L Wentz
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adaora A Adimora
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Lisa Metsch
- Sociomedical Sciences, Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, California, USA
- Department of Veteran Affairs Medical Center, San Francisco, California, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
- Center for AIDS Prevention Studies, University of California, San Francisco, California, USA
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Wright L, Sanchez A, Jakubec P, Ross J. Food Fighters: A Food Recovery-Meal Delivery Program Benefits Meal Recipients, Volunteers and Agencies. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021. [DOI: 10.1080/19320248.2021.1883496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Lauri Wright
- Center for Nutrition and Food Security, University of North Florida, Jacksonville, Florida, USA
| | - Alice Sanchez
- Center for Nutrition and Food Security, University of North Florida, Jacksonville, Florida, USA
| | - Patricia Jakubec
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Jen Ross
- Center for Nutrition and Food Security, University of North Florida, Jacksonville, Florida, USA
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Nguyen AL, Davtyan M, Taylor J, Christensen C, Plankey M, Karpiak S, Brown B. Living With HIV During the COVID-19 Pandemic: Impacts for Older Adults in Palm Springs, California. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:265-275. [PMID: 34370567 PMCID: PMC8496895 DOI: 10.1521/aeap.2021.33.4.265] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We conducted surveys in March 2020 with 100 older adults living in Palm Springs, CA, to (1) report the impact of the COVID-19 pandemic on their day-to-day well-being and (2) describe the factors related to missing HIV medication during the pandemic. Respondent's mean age was 64.2 and the majority identified as White, men, and gay. The majority stated that the pandemic had impacted their lives "much," "very much," or "extremely." One-third experienced financial challenges and 46.0% experienced disruptions to health care. Almost a quarter (24.0%) reported missing a dose of their HIV medication during the pandemic. Compared to those ages 64+, younger respondents were more likely to report some negative impacts like changes in sleep patterns, financial challenges, and missed HIV medication doses, and had higher PTSD severity scores. In adjusted logistic regression, higher PTSD severity scores and disruption to health care were associated with missed doses of medications (ps < .05).
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Affiliation(s)
- Annie L Nguyen
- University of Southern California, Los Angeles, California
| | - Mariam Davtyan
- University of Southern California, Los Angeles, California
| | - Jeff Taylor
- HIV + Aging Research Project-Palm Springs (HARP-PS), Palm Springs, California
| | | | | | - Stephen Karpiak
- HIV and Aging Center, ACRIA Center on HIV & Aging at GMHC, New York, New York
| | - Brandon Brown
- University of California, Riverside School of Medicine
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Folayan MO, Ibigbami O, El Tantawi M, Brown B, Aly NM, Ezechi O, Abeldaño GF, Ara E, Ayanore MA, Ellakany P, Gaffar B, Al-Khanati NM, Idigbe I, Ishabiyi AO, Jafer M, Khan ATA, Khalid Z, Lawal FB, Lusher J, Nzimande NP, Osamika BE, Quadri MFA, Roque M, Al-Tammemi AB, Yousaf MA, Virtanen JI, Zuñiga RAA, Okeibunor JC, Nguyen AL. Factors Associated with Financial Security, Food Security and Quality of Daily Lives of Residents in Nigeria during the First Wave of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7925. [PMID: 34360217 PMCID: PMC8345729 DOI: 10.3390/ijerph18157925] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/16/2021] [Accepted: 07/18/2021] [Indexed: 12/19/2022]
Abstract
An online survey was conducted to identify factors associated with financial insecurity, food insecurity and poor quality of daily lives of adults in Nigeria during the first wave of the COVID-19 pandemic. The associations between the outcome (experience of financial loss, changes in food intake and impact of the pandemic on daily lives) and the explanatory (age, sex, education level, anxiety, depression, HIV status) variables were determined using logistic regression analysis. Of the 4439 respondents, 2487 (56.0%) were financially insecure, 907 (20.4%) decreased food intake and 4029 (90.8%) had their daily life negatively impacted. Males (AOR:0.84), people who felt depressed (AOR:0.62) and people living with HIV -PLHIV- (AOR:0.70) had significantly lower odds of financial insecurity. Older respondents (AOR:1.01) had significantly higher odds of financial insecurity. Those depressed (AOR:0.62) and PLHIV (AOR:0.55) had significantly lower odds of reporting decreased food intake. Respondents who felt anxious (AOR:0.07), depressed (AOR: 0.48) and who were PLHIV (AOR:0.68) had significantly lower odds of reporting a negative impact of the pandemic on their daily lives. We concluded the study findings may reflect a complex relationship between financial insecurity, food insecurity, poor quality of life, mental health, and socioeconomic status of adults living in Nigeria during the COVID-19 pandemic.
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Affiliation(s)
- Morenike Oluwatoyin Folayan
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
| | - Olanrewaju Ibigbami
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
| | - Maha El Tantawi
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria 21527, Egypt
| | - Brandon Brown
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Social Medicine, Population and Public Health, School of Medicine, University of California, Riverside, CA 92501, USA
| | - Nourhan M. Aly
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria 21527, Egypt
| | - Oliver Ezechi
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Clinical Sciences, Nigerian Institute of Medical Research, Lagos 101212, Nigeria
| | - Giuliana Florencia Abeldaño
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Institute for Research on Public Health, School of Medicine, University of Sierra Sur, Oaxaca 70805, Mexico
| | - Eshrat Ara
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Government College for Women, Moulana Azad Road, Srinagar Kashmir, J&K 190001, India
| | - Martin Amogre Ayanore
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Health Policy Planning and Management, University of Health and Allied Sciences, PMB 31 Ho, Ghana
| | - Passent Ellakany
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Balgis Gaffar
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Preventive Dentistry, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Nuraldeen Maher Al-Khanati
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Syrian Private University, Damascus 36822, Syria
| | - Ifeoma Idigbe
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Clinical Sciences, Nigerian Institute of Medical Research, Lagos 101212, Nigeria
| | - Anthonia Omotola Ishabiyi
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Mohammed Jafer
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Preventive Dental Sciences, Faculty of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Abeedha Tu-Allah Khan
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- School of Biological Sciences, University of the Punjab, Quaid-i-Azam Campus, Lahore 54590, Pakistan
| | - Zumama Khalid
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- School of Biological Sciences, University of the Punjab, Quaid-i-Azam Campus, Lahore 54590, Pakistan
| | - Folake Barakat Lawal
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Periodontology and Community Dentistry, University of Ibadan, Ibadan 200212, Nigeria
| | - Joanne Lusher
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- School of Health and Life Sciences, University of the West of Scotland, London E142BE, UK
| | - Ntombifuthi P. Nzimande
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Economic and Human Geography, Faculty of Geosciences, University of Szeged, H-6722 Szeged, Hungary
| | - Bamidele Emmanuel Osamika
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Psychology, Faculty of Environment, Management and Social Sciences, Lead City University, Ibadan 200255, Nigeria
| | - Mir Faeq Ali Quadri
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Division of Dental Public Health, Department of Preventive Dentistry, Jazan University, Jazan 45142, Saudi Arabia
| | - Mark Roque
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Maternity & Childhood Nursing, College of Nursing, Taibah University, Madinah 42223, Saudi Arabia
| | - Ala’a B. Al-Tammemi
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Family and Occupational Medicine, Faculty of Medicine, Doctoral School of Health Sciences, University of Debrecen, H-4032 Debrecen, Hungary
| | - Muhammad Abrar Yousaf
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Institute of Zoology, University of the Punjab, Quaid-i-Azam Campus, Lahore 54590, Pakistan
| | - Jorma I. Virtanen
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Faculty of Medicine, University of Turku, FI-20014 Turku, Finland
| | - Roberto Ariel Abeldaño Zuñiga
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Post Graduate School, University of Sierra Sur, Oaxaca 70800, Mexico
| | - Joseph Chukwudi Okeibunor
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Research Development and Innovations, Assistant Regional Director Cluster, WHO Regional Office for Africa, Brazzaville BP 06, Congo
| | - Annie Lu Nguyen
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 91803, USA
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White M, Feucht UD, du Toit LDV, Rossouw T, Connor KL. Understanding the Impact of Maternal HIV Infection on the Health and Well-Being of Mothers and Infants in South Africa: Siyakhula Collaborative Workshop Report. J Multidiscip Healthc 2021; 14:1987-1999. [PMID: 34335029 PMCID: PMC8319554 DOI: 10.2147/jmdh.s317829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/01/2021] [Indexed: 11/23/2022] Open
Abstract
The Siyakhula study is an ongoing, observational cohort study in Pretoria, South Africa, that aims to understand how maternal HIV infection and perinatal environmental factors shape development and health in infants who are HIV-exposed (in utero and during breastfeeding) but remain uninfected themselves (HEU). The Siyakhula Collaborative Workshop, which took place at the Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies at Kalafong Hospital in Pretoria, South Africa on November 15–16, 2018, brought together a group of international health scientists, clinicians, and stakeholders, including women with lived experience, to build capacity for research and training on the impact of HIV infection on women’s and infants’ health across geographical and disciplinary boundaries. The workshop sought to summarise the state of knowledge on the effects of being HEU on infant development and health in the first two years of life, identify gaps in existing research on modifiable exposures that may be associated with poor infant development, and develop ideas for novel research and interventions to lessen or prevent adverse health outcomes in pregnant or breastfeeding people living with HIV. These proceedings summarise the pre-workshop consensus process that was used to identify priority areas to discuss during small-group breakout sessions, as well as the themes and key challenges that emerged from these discussions during the workshop.
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Affiliation(s)
- Marina White
- Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Ute D Feucht
- Paediatrics, University of Pretoria, Pretoria, Gauteng, South Africa.,Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, Gauteng, South Africa.,Maternal and Infant Health Care Strategies Unit, South African Medical Council, Pretoria, Gauteng, South Africa
| | | | - Theresa Rossouw
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, Gauteng, South Africa.,Maternal and Infant Health Care Strategies Unit, South African Medical Council, Pretoria, Gauteng, South Africa.,Department of Immunology, University of Pretoria, Pretoria, Gauteng, South Africa
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Beymer MR, Reagan JJ, Rabbitt MP, Webster AE, Watkins EY. Association between Food Insecurity, Mental Health, and Intentions to Leave the US Army in a Cross-Sectional Sample of US Soldiers. J Nutr 2021; 151:2051-2058. [PMID: 33982122 DOI: 10.1093/jn/nxab089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/16/2021] [Accepted: 03/09/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous research has demonstrated that certain groups in the United States are at a greater risk for food insecurity. However, food insecurity has not been sufficiently characterized in active duty military populations. OBJECTIVES The primary objective of this study was to determine the prevalence of marginal food insecurity at a large US Army installation. The secondary objective was to determine how marginal food insecurity may be associated with intentions to leave the US Army after the current service period ("intentions to leave"). METHODS A cross-sectional, online survey was administered by the US Army Public Health Center at an Army installation in 2019 (n = 5677). The main predictor was the 2-item food insecurity screener (Hunger Vital Signs), and the main outcome was a 5-point Likert question, "How likely are you to leave the army after your current enlistment/service period?" that was dichotomized for this analysis. Multiple logistic regression was used to assess the association between marginal food insecurity and intentions to leave. Mental health covariates were analyzed as a potential mediator. RESULTS The sample was primarily male (83%), age <25 y (49%), and White (56%). One-third of respondents were classified as marginally food insecure using the Hunger Vital Signs, and 52% had intentions to leave. There was no significant association between marginal food insecurity and intentions to leave in the composite multivariable model, but mediation analyses revealed that food insecurity was significantly and independently associated with anxiety, depression, and suicidal ideation, which was in turn associated with intentions to leave. CONCLUSIONS The association between marginal food insecurity and mental health showed that addressing food insecurity could improve mental health and subsequently reduce intentions to leave. Solutions to reduce military food hardship include expanding Supplemental Nutrition Assistance Program eligibility requirements, improving food resources communication, and expanding healthy food choices on-post.
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Affiliation(s)
- Matthew R Beymer
- US Army Public Health Center, Behavioral and Social Health Outcomes Program, Aberdeen Proving Ground, Aberdeen, MD, USA
| | - Joanna J Reagan
- US Army Public Health Center, Health Promotion and Wellness Directorate, Aberdeen Proving Ground, Aberdeen, MD, USA
| | - Matthew P Rabbitt
- US Department of Agriculture, Economic Research Service, Kansas City, MO, USA
| | - Abby E Webster
- US Army Public Health Center, Behavioral and Social Health Outcomes Program, Aberdeen Proving Ground, Aberdeen, MD, USA
| | - Eren Y Watkins
- US Army Public Health Center, Behavioral and Social Health Outcomes Program, Aberdeen Proving Ground, Aberdeen, MD, USA
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Food insecurity partially mediates the association between drug use and depressive symptoms among men who have sex with men in Los Angeles, California. Public Health Nutr 2021; 24:3977-3985. [PMID: 34103117 DOI: 10.1017/s1368980021002494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To understand the relationship between drug use, food insecurity (FI) and mental health among men who have sex with men (MSM). DESIGN Cohort study (2014-2019) with at least one follow-up. SETTING Visits at 6-month intervals included self-assessment for FI and depressive symptoms. Urine testing results confirmed drug use. Factors associated with FI were assessed using multiple logistic regression with random effects for repeated measures. General structural equation modelling tested whether FI mediates the relationship between drug use and depressive symptoms. PARTICIPANTS Data were from HIV-positive and high-risk HIV-negative MSM in Los Angeles, CA (n 431; 1192 visits). RESULTS At baseline, FI was reported by 50·8 % of participants, depressive symptoms in 36·7 % and 52·7 % of urine screening tests were positive for drugs (i.e. marijuana, opioids, methamphetamine, cocaine and ecstasy). A positive drug test was associated with a 96 % increase in the odds of being food insecure (95 % CI 1·26, 3·07). Compared to those with high food security, individuals with very low food security have a nearly sevenfold increase in the odds of reporting depressive symptoms (95 % CI 3·71, 11·92). Findings showed 14·9 % of the association between drug use (exposure) and depressive symptoms (outcome) can be explained by FI (mediator). CONCLUSION The prevalence of FI among this cohort of HIV-positive and high-risk HIV-negative MSM was high; the association between drug use and depressive symptoms was partially mediated by FI. Findings suggest that enhancing access to food and nutrition may improve mood in the context of drug use, especially among MSM at risk for HIV transmission.
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Miller JD, Frongillo EA, Weke E, Burger R, Wekesa P, Sheira LA, Mocello AR, Bukusi EA, Otieno P, Cohen CR, Weiser SD, Young SL. Household Water and Food Insecurity Are Positively Associated with Poor Mental and Physical Health among Adults Living with HIV in Western Kenya. J Nutr 2021; 151:1656-1664. [PMID: 33709134 PMCID: PMC8243794 DOI: 10.1093/jn/nxab030] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/04/2021] [Accepted: 01/26/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Household food insecurity (FI) and water insecurity (WI) are prevalent public health issues that can co-occur. Few studies have concurrently assessed their associations with health outcomes, particularly among people living with HIV. OBJECTIVES We aimed to investigate the associations between FI and WI and how they relate to physical and mental health. METHODS Food-insecure adult smallholder farmers living with HIV in western Kenya were recruited to participate in a cluster-randomized controlled trial of a multisectoral agricultural and asset loan intervention. We used baseline data on experiences of FI (using the Household Food Insecurity Access Scale, range: 0-27) and WI (using a modified scale developed for this region, range: 0-51) in the prior month (n = 716). Outcomes included probable depression (using the Hopkins Symptom Checklist), fatigue and diarrhea in the prior month, and overall mental and physical health (using the Medical Outcomes Study HIV Health Survey, range: 0-100). We first assessed Pearson correlations between FI, WI, and sociodemographic characteristics. We then developed 3 regressions for each health outcome (control variables and FI; control variables and WI; control variables, FI, and WI) and compared model fit indexes. RESULTS Correlations between household FI, WI, and wealth were low, meaning they measure distinct constructs. FI and WI were associated with numerous physical and mental health outcomes; accounting for both resource insecurities typically provided the best model fit. For instance, when controlling for FI, each 10-point higher WI score was associated with a 6.42-point lower physical health score (P < 0.001) and 2.92 times greater odds of probable depression (P < 0.001). CONCLUSIONS Assessing both FI and WI is important for correctly estimating their relation with health outcomes. Interventions that address food- and water-related issues among persons living with HIV concurrently will likely be more effective at improving health than those addressing a single resource insecurity. This trial was registered at clinicaltrials.gov as NCT02815579.
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Affiliation(s)
- Joshua D Miller
- Department of Anthropology, Northwestern
University, Evanston, IL, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior,
University of South Carolina, Columbia, SC, USA
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research
Institute, Nairobi, Kenya
| | - Rachel Burger
- Department of Obstetrics, Gynecology & Reproductive
Sciences, University of California San Francisco, San
Francisco, CA, USA
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research
Institute, Nairobi, Kenya
| | - Lila A Sheira
- Department of Medicine, University of California San
Francisco, San Francisco, CA, USA
| | - A Rain Mocello
- Department of Obstetrics, Gynecology & Reproductive
Sciences, University of California San Francisco, San
Francisco, CA, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research
Institute, Nairobi, Kenya
- Department of Obstetrics, Gynecology & Reproductive
Sciences, University of California San Francisco, San
Francisco, CA, USA
| | - Phelgona Otieno
- Centre for Clinical Research, Kenya Medical Research
Institute, Nairobi, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive
Sciences, University of California San Francisco, San
Francisco, CA, USA
| | - Sheri D Weiser
- Department of Medicine, University of California San
Francisco, San Francisco, CA, USA
| | - Sera L Young
- Department of Anthropology, Northwestern
University, Evanston, IL, USA
- Institute for Policy Research, Northwestern
University, Evanston, IL, USA
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Alvarez GG, Miller JD, Santoso MV, Wekesa P, Owuor PM, Onono M, Young SL. Prevalence and Covariates of Food Insecurity Across the First 1000 Days Among Women of Mixed HIV Status in Western Kenya: A Longitudinal Perspective. Food Nutr Bull 2021; 42:319-333. [PMID: 34011176 DOI: 10.1177/0379572121999024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Food insecurity (FI) is common globally and can have lifelong consequences. However, few studies have longitudinally examined how FI varies across gestation and the postpartum period ("the first 1000 days"); none have explored this in sub-Saharan Africa or in the context of HIV. OBJECTIVE To assess the prevalence and covariates of FI in the first 1000 days among Kenyan women. METHODS All pregnant women attending 7 clinics in western Kenya (n = 1247) were screened for HIV and FI (Individual Food Insecurity Access Scale) between September 2014 and June 2015. A subset of women (n = 371) was recruited into an observational cohort study and surveyed 11 times through 2 years postpartum (NCT02974972, NCT02979418). Data on FI, sociodemographics, and health were repeatedly collected. Severe FI was modeled using multilevel, mixed-effects logistic regressions (n = 346). RESULTS Of the 1247 pregnant women screened, 76.5% were severely food insecure in the prior month. Further, the prevalence of severe FI was higher among women living with HIV than those without (82.6% vs 74.6%, P < .05). In the cohort, the odds of being severely food insecure decreased monotonically after delivery. Each point higher on the Center for Epidemiologic Studies-Depression scale was associated with 1.08 times greater odds of being severely food insecure (95% CI: 1.05-1.10); each point higher on the Duke/UNC Functional Social Support Scale was associated with 0.97 lower odds of severe FI (95% CI: 0.94-0.99). CONCLUSIONS Severe FI is prevalent during the first 1000 days in western Kenya. Services to mitigate the far-reaching consequences of this modifiable risk should be considered.
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Affiliation(s)
- Gloria G Alvarez
- Gerald J. And Dorothy R. Friedman School of Nutrition Science and Policy, 1810Tufts University, Boston, MA, USA.,* Gloria G. Alvarez and Joshua D. Miller contributed equally to the manuscript
| | - Joshua D Miller
- Department of Anthropology, 3270Northwestern University, Evanston, IL, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, NC, USA.,* Gloria G. Alvarez and Joshua D. Miller contributed equally to the manuscript
| | - Marianne V Santoso
- Department of Anthropology, 3270Northwestern University, Evanston, IL, USA
| | | | | | | | - Sera L Young
- Department of Anthropology, 3270Northwestern University, Evanston, IL, USA.,Institute for Policy Research, 3270Northwestern University
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Tamargo JA, Hernandez-Boyer J, Teeman C, Martin HR, Huang Y, Johnson A, Campa A, Martinez SS, Li T, Rouster SD, Meeds HL, Sherman KE, Baum MK. Immune activation: A link between food insecurity and chronic disease in people living with HIV. J Infect Dis 2021; 224:2043-2052. [PMID: 33993311 DOI: 10.1093/infdis/jiab257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/11/2021] [Indexed: 11/14/2022] Open
Abstract
Persistent immune activation is a hallmark of HIV infection and thought to play a role on chronic diseases in people with HIV (PWH). Food insecurity is disproportionately prevalent in PWH and is associated with adverse health outcomes. We determined whether food insecurity was associated with increased plasma levels of sCD14, sCD27, and sCD163 in 323 antiretroviral -treated PWH from the Miami Adult Studies on HIV (MASH) Cohort. Nearly half (42.7%) of participants were food insecure and 85.5% were virally suppressed (<200 copies/mL). Food insecurity was independently associated with higher levels of sCD14 and sCD27. Very low food security was associated with increased sCD163 levels among those with lower CD4+ cell counts. Food insecurity may promote immune activation in PWH, suggesting a biological link between food insecurity and chronic disease among PWH. Improving financial security and access to high-quality diets could reduce the burden of disease in this highly vulnerable population.
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Affiliation(s)
- Javier A Tamargo
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | | | - Colby Teeman
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Haley R Martin
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Yongjun Huang
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Angelique Johnson
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Adriana Campa
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Sabrina S Martinez
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Tan Li
- Department of Biostatistics, Florida International University, Miami, FL, USA
| | - Susan D Rouster
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Heidi L Meeds
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Marianna K Baum
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
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Improving the measurement of food insecurity among people with HIV in South Africa: a psychometric examination. Public Health Nutr 2021; 24:3805-3817. [PMID: 33769239 DOI: 10.1017/s1368980021001312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Food insecurity is a structural barrier to HIV care in peri-urban areas in South Africa (SA), where approximately 80 % of households are moderately or severely food insecure. For people with HIV (PWH), food insecurity is associated with poor antiretroviral therapy adherence and survival rates. Yet, measurement of food insecurity among PWH remains a challenge. DESIGN The current study examines the factor structure of the nine-item Household Food Insecurity Access Scale (HFIAS, isiXhosa-translated) among PWH in SA using a restrictive bifactor model. SETTING Primary care clinics in Khayelitsha, a peri-urban settlement in Cape Town, SA. PARTICIPANTS Participants (n 440) were PWH who received HIV care in Khayelitsha screening for a clinical trial. Most were categorised as severely (n 250, 56·82 %) or moderately (n 107, 24·32 %) food insecure in the past 30 d. RESULTS Revised parallel analysis suggested a three-factor structure, which was inadmissible. A two-factor structure was examined but did not adequately fit the data. A two-factor restrictive bifactor model was examined, such that all items loaded on a general factor (food insecurity) and all but two items loaded on one of two specific additional factors, which adequately fit the data (comparative fit index = 0·995, standardised root mean square residual = 0·019). The two specific factors identified were: anxiety/insufficient quality and no food intake. Reliability was adequate (ω = 0·82). CONCLUSIONS Results supported the use of a total score, and identified two specific factors of the HFIAS, which may be utilised in future research and intervention development. These findings help identify aspects of food insecurity that may drive relationships between the construct and important HIV-related variables.
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Benzekri NA, Sambou JF, Ndong S, Diallo MB, Tamba IT, Faye D, Sall I, Diatta JP, Faye K, Cisse O, Sall F, Guèye NFN, Ndour CT, Sow PS, Malomar JJ, Hawes SE, Seydi M, Gottlieb GS. The impact of food insecurity on HIV outcomes in Senegal, West Africa: a prospective longitudinal study. BMC Public Health 2021; 21:451. [PMID: 33676463 PMCID: PMC7936446 DOI: 10.1186/s12889-021-10444-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Understanding the impact of food insecurity on HIV outcomes is critical for the development and implementation of effective, evidence-based interventions to address food insecurity and improve the HIV care cascade. We conducted a prospective, longitudinal study to determine the impact of food insecurity on HIV outcomes in Senegal, West Africa. Methods HIV-infected individuals presenting for care and initiation of ART through the Senegalese National AIDS program in Dakar and Ziguinchor were eligible for enrollment. Data were collected using interviews, clinical evaluations, laboratory analyses, and chart review at enrollment, month 6, and month 12. Logistic regression was used to determine the association between food insecurity and HIV outcomes. Results Among the 207 participants in this study, 70% were female and the median age was 37 years. The majority (69%) were food insecure at enrollment, 29% were severely food insecure, and 38% were undernourished. Nearly a third (32%) had no formal education, 23% practiced agriculture, and 40% owned livestock. The median daily food expenditure per person was $0.58. The median round trip transportation time to clinic was 90 min (IQR 30–240). The median cost of transportation to clinic was $1.74. At month 12, 69% were food insecure, 23% were severely food insecure, and 14% were undernourished. At month 12, 43% had not disclosed their HIV status; food insecurity was associated with non-disclosure of HIV-status due to fear of stigmatization and feelings of shame. Severe food insecurity was a strong predictor of loss to follow-up (OR 3.13 [1.08–9.06]) and persistent severe food insecurity was associated with virologic failure (OR 5.14 [1.01–26.29]) and poor adherence to ART 8.00 [1.11–57.57]. Poor nutritional status was associated with poor immunologic recovery (OR 4.24 [1.56–11.47]), virologic failure (OR 3.39 [1.13–10.21]), and death (OR 3.35 [1.40–8.03]). Conclusion Severity and duration of food insecurity are important factors in understanding the relationship between food insecurity and HIV outcomes. Our findings highlight the importance of nutritional status, socioeconomic opportunity, and self-stigmatization in the complex pathway between food insecurity and HIV outcomes. Interdisciplinary, multisectoral efforts are needed to develop and implement effective interventions to address food insecurity among people living with HIV. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10444-1.
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Affiliation(s)
- Noelle A Benzekri
- Department of Medicine, University of Washington, Box 358061, 750 Republican St., Seattle, WA, 98109-4725, USA.
| | | | - Sanou Ndong
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Mouhamadou Baïla Diallo
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | | | | | | | | | - Khadim Faye
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | | | - Fatima Sall
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Ndèye Fatou Ngom Guèye
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Cheikh T Ndour
- Division de Lutte contre le Sida et les IST, Ministère de la Santé et de l'Action Sociale, Dakar, Senegal
| | - Papa Salif Sow
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | | | - Stephen E Hawes
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Moussa Seydi
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Geoffrey S Gottlieb
- Department of Medicine, University of Washington, Box 358061, 750 Republican St., Seattle, WA, 98109-4725, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
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Groene EA, Valeris-Chacin RJ, Stadelman AM, Safo SE, Cusick SE. Maternal HIV and child anthropometric outcomes over time: an analysis of Zimbabwe demographic health surveys. AIDS 2021; 35:477-484. [PMID: 33252491 PMCID: PMC7855570 DOI: 10.1097/qad.0000000000002772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To understand the association between children's anthropometric measures and maternal HIV status in Zimbabwe and to determine whether these relationships changed over time. DESIGN Data from Demographic Health Surveys in Zimbabwe rounds 2005, 2010, and 2015 were used to conduct cross-sectional analyses of child anthropometric measures (stunting, underweight, and wasting). METHODS Using separate logistic regression models for each of the anthropometric measures, we estimated the adjusted prevalence odds ratio (OR) of stunting, underweight, and wasting in children according to maternal HIV status. Moreover, we evaluated an interaction by survey year to evaluate change over time. RESULTS Children of mothers with HIV had 32% greater odds [OR = 1.32, 95% confidence interval (CI) 1.16-1.5] of stunting, 27% greater odds (OR = 1.27, 95% CI 1.1-1.48) of underweight status and 7% greater odds (OR = 1.07, 95% CI 0.81-1.42) of wasting status, than children of mothers without HIV. These associations between maternal HIV status and child undernutrition did not differ by year (P > 0.05 for all interaction terms). CONCLUSION In Zimbabwe, having a mother who tested positive for HIV at the time of the survey has been associated with greater child undernutrition over the last two decades with no significant change by survey round. This emphasizes the need for continued programming to address nutritional deficiencies, sanitation, and infectious disease prevention in this high-risk population. The greatest impact of maternal HIV status has been on child stunting and underweight, associated with poor long-term child development.
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Affiliation(s)
- Emily A Groene
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
| | | | - Anna M Stadelman
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
| | - Sandra E Safo
- Division of Biostatistics, University of Minnesota School of Public Health
| | - Sarah E Cusick
- University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
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Sahile AT, Ayehu SM, Fanta SF. Underweight and Its Predictors Among Patients on Anti Retroviral Therapy at Selected Health Facilities of Addis Ababa, Ethiopia, 2020. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:99-106. [PMID: 33536793 PMCID: PMC7847765 DOI: 10.2147/hiv.s292902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/06/2021] [Indexed: 11/23/2022]
Abstract
Objective The study aimed at assessing the prevalence of underweight and its predictors in patients on ART, in health facilities of Addis Ababa, Ethiopia, 2020. Methods A multi-center-based cross-sectional study was conducted among 319 patients on ART selected on the basis of stratified sampling method in Addis Ababa from July 01 to August 30, 2020. An interviewer-administered structured questionnaire was used for collection of the data, after which informed consent was obtained from all the included participants. Descriptive statistics for the summarization of the data was used. Binary (Bivariate and multivariate) logistics regression was applied for the identification of predictors of underweight and its strength of association with their respective 95% confidence intervals and less than 5% p-values as statistically significant association. Findings The prevalence of underweight among patients on ART was 19.1% (95% CI: 15.0-23.9%), while more than one-tenth (14.4%) of the participants were overweight (95% CI: 10.8-18.8%). A higher level of Educational level, being married, widowed, divorced, a lower family size and poor ART drug adherence level were statistically significantly associated with an increased risk of underweight among patients on ART in the study settings (p<0.05). Conclusion Educational level, marital status, family size, and adherence status of the participants were identified predictors of underweight among patients on ART. The lower the educational level, lower family size, being either married, divorced, or widowed, having had of poor ART drug adherence level of the participants, the higher their risk of sustaining underweight. Concerned bodies were suggested to work over the identified determinants of underweight among patients on ART in the study settings.
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Tamargo JA, Sherman KE, Campa A, Martinez SS, Li T, Hernandez J, Teeman C, Mandler RN, Chen J, Ehman RL, Baum MK. Food insecurity is associated with magnetic resonance-determined nonalcoholic fatty liver and liver fibrosis in low-income, middle-aged adults with and without HIV. Am J Clin Nutr 2021; 113:593-601. [PMID: 33515016 PMCID: PMC7948863 DOI: 10.1093/ajcn/nqaa362] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in the United States. Food-insecure individuals often depend on low-cost, energy-dense but nutritionally poor foods, resulting in obesity and chronic diseases related to NAFLD. OBJECTIVES To determine whether food insecurity is associated with NAFLD in a cohort of HIV and hepatitis C virus (HCV) infected and uninfected adults. METHODS We conducted a cross-sectional analysis of low-income, middle-aged adults from the Miami Adult Studies on HIV (MASH) cohort without a history of excessive alcohol consumption. Food security was assessed with the USDA's Household Food Security Survey. MRIs were used to assess liver steatosis and fibrosis. Metabolic parameters were assessed from fasting blood, anthropometrics, and vitals. RESULTS Of the total 603 participants, 32.0% reported food insecurity. The prevalences of NAFLD, fibrosis, and advanced fibrosis were 16.1%, 15.1%, and 4.6%, respectively. For every 5 kg/m2 increase in BMI, the odds of NAFLD increased by a factor of 3.83 (95% CI, 2.37-6.19) in food-insecure participants compared to 1.32 (95% CI, 1.04-1.67) in food-secure participants. Food insecurity was associated with increased odds for any liver fibrosis (OR, 1.65; 95% CI, 1.01-2.72) and advanced liver fibrosis (OR, 2.82; 95% CI, 1.22-6.54), adjusted for confounders. HIV and HCV infections were associated with increased risks for fibrosis, but the relationship between food insecurity and liver fibrosis did not differ between infected and uninfected participants. CONCLUSIONS Among low-income, middle-aged adults, food insecurity exacerbated the risk for NAFLD associated with a higher BMI and independently increased the risk for advanced liver fibrosis. People who experience food insecurity, particularly those vulnerable to chronic diseases and viral infections, may be at increased risk for liver-related morbidity and mortality. Improving access to adequate nutrition and preventing obesity among low-income groups may lessen the growing burden of NAFLD and other chronic diseases.
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Affiliation(s)
| | | | | | | | - Tan Li
- Florida International University, Miami, FL, USA
| | | | - Colby Teeman
- Florida International University, Miami, FL, USA
| | | | - Jun Chen
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Doostan F, Amirinejad A, Rahimlou M, Hassanzadeh M, Sharafkhani R. Prevalence of household food insecurity among people living with HIV/AIDS (Kerman- the southeast of Iran). Med J Islam Repub Iran 2021; 35:14. [PMID: 33996665 PMCID: PMC8111646 DOI: 10.47176/mjiri.35.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Household food insecurity is one of the major public health issues that may affect an individual’s nutritional state, especially in patients with chronic diseases. The aim of this study was to evaluate the prevalence of household food insecurity and its association with sociodemographic and clinical factors among patients with HIV/AIDS in Kerman province, Iran.
Methods: A cross sectional study was performed among the 179 patients with HIV/AIDS in Kerman province. Participants completed a questionnaire focusing on personal information, health, and clinical status. Also, household food security status was evaluated by the USDA (US Department of Agriculture) questionnaire. Data were analyzed using SPSS (Version 22) by descriptive, univariate, and multivariate logistic regression. P<0.05 was considered statistically significant.
Results: Overall, 98 responding men and women were classified as household food secure (n=41; 40.8%) and household food insecure (n=58; 59.2%). Among the household food insecure patients, 14% (n=8) experienced lower household food insecurity, 38% (n=22) moderate household food insecurity, and 48% (n=28) severe household food insecurity. No significant differences were observed between household food secure and insecure groups in demographic variables. In clinical variables, only BMI index was significantly different between the two groups (p=0.040), but CD4 count was not significant between groups (p=0.220).
Conclusion: Prevalence of household food insecurity was high among people living with HIV/AIDS in Kerman. It seems clinical variables such as BMI index, which indicates the nutritional status of individuals, affect household food security status among people living with HIV/AIDS.
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Affiliation(s)
- Farideh Doostan
- Department of Nutrition, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Amirinejad
- Department of Nutrition, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehran Rahimlou
- Department of Nutrition, School of Para-medicine, Ahvaz Jundishapur University of Medical Sciences, Iran
| | - Mehran Hassanzadeh
- Department of Nutrition, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Rahim Sharafkhani
- Department of Public Health, School of Public Health, Khoy University of Medical Sciences, Khoy, Iran
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Relapse into Undernutrition in a Nutritional Program in HIV Care and the Impact of Food Insecurity: A Mixed-Methods Study in Tigray Region, Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020732. [PMID: 33467012 PMCID: PMC7829869 DOI: 10.3390/ijerph18020732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 11/17/2022]
Abstract
The relapse into undernutrition after nutritional recovery among those enrolled in a nutritional program is a common challenge of nutritional programs in HIV care settings, but there is little evidence on the determinants of the relapse. Nutritional programs in HIV care settings in many countries are not well designed to sustain the gains obtained from enrolment in a nutritional program. This study examined relapse into undernutrition and associated factors among people living with HIV in the Tigray region of Ethiopia. The study employed a mixed-methods approach, involving quantitative and qualitative studies. Among those who graduated from the nutritional program, 18% of adults and 7% of children relapsed into undernutrition. The mean time to relapse for adults was 68.5 months (95% CI, 67.0-69.9). Various sociodemographic, clinical, and nutritional characteristics were associated with a relapse into undernutrition. A considerable proportion of adults and children relapsed after nutritional recovery. Food insecurity and poor socioeconomic status were a common experience among those enrolled in the nutritional program. Hence, nutritional programs should design strategies to sustain the nutritional gains of those enrolled in the nutritional programs and address the food insecurity which was reported as one of the contributors to relapse into undernutrition among the program participants.
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Stephens JH, Surjan A. Barriers Preventing Access by Men who have Sex with Men to HIV-related health services in Southeast Asia: A Scoping Review. Glob Public Health 2020; 17:235-253. [PMID: 33317394 DOI: 10.1080/17441692.2020.1858922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The objective of this scoping review was to identify and describe barriers experienced by men who have sex with men (MSM) when accessing HIV-related health care in Southeast Asia. A systematic search identified thirteen papers, which were full text reviewed and data extracted. An intersection of stigma and discrimination, fear and shame, cultural norms and societal expectations coalesce to influence the ability, either physically through lack of service provision or emotionally through personal restraint, of MSM to access HIV-related health services. Many of the factors continuing to drive the ongoing HIV epidemic across the Southeast Asia region have humanitarian origin - access to safe and non-discriminatory healthcare, education on sexual health, and not being persecuted for having a health condition. These must be addressed with an interdisciplinary response at local, government and regional level.
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Affiliation(s)
- Jacqueline H Stephens
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Akhilesh Surjan
- Emergency & Disaster Management, College of Indigenous Futures, Arts and Society, Charles Darwin University, Darwin, Australia
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