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Fernandez SB, Dawit R, Nawfal ES, Ward MK, Ramirez-Ortiz D, Sheehan DM, Trepka MJ. Psychosocial and socioeconomic changes among low-income people with HIV during the COVID-19 pandemic in Miami-Dade County, Florida: racial/ethnic and gender differences. HIV Res Clin Pract 2024; 25:2363129. [PMID: 38907537 PMCID: PMC11256985 DOI: 10.1080/25787489.2024.2363129] [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: 03/12/2024] [Accepted: 05/29/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND COVID-19 profoundly and uniquely impacted people with HIV. People with HIV experienced significant psychosocial and socioeconomic impacts, yet a limited amount of research has explored potential differences across gender and racial/ethnic groups of people with HIV. OBJECTIVE The objective of this study was to examine psychosocial and socioeconomic stressors related to the COVID-19 pandemic among a diverse sample of people with HIV in South Florida and to determine if the types of stressors varied across gender and racial/ethnic groups. METHODS We analyzed data from a cross-sectional survey with Miami-Dade County, Ryan White Program recipients. Outcomes included mental health, socioeconomic, drug/alcohol, and care responsibility/social support changes. Weighted descriptive analyses provided an overview of stressors by gender and racial/ethnic group and logistic regressions estimated associations between demographics and stressors. RESULTS Among 291 participants, 39% were Non-Hispanic Black, 18% were Haitian, and 43% were Hispanic. Adjusting for age, sex, language, and foreign-born status, Hispanics were more likely to report several worsened mental health (i.e. increased loneliness, anxiety) and socioeconomic stressors (i.e. decreased income). Spanish speakers were more likely to report not getting the social support they needed. Women were more likely to report spending more time caring for children. CONCLUSIONS Findings highlight ways in which cultural and gender expectations impacted experiences across people with HIV and suggest strategies to inform interventions and resources during lingering and future public health emergencies. Results suggest that public health emergencies have different impacts on different communities. Without acknowledging and responding to differences, we risk losing strides towards progress in health equity.
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Affiliation(s)
- Sofia B. Fernandez
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
- Research Center for Minority Institutions, Florida International University, Miami, FL, USA
| | - Rahel Dawit
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ekpereka Sandra Nawfal
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Melissa K. Ward
- Research Center for Minority Institutions, Florida International University, Miami, FL, USA
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Daisy Ramirez-Ortiz
- Research Center for Minority Institutions, Florida International University, Miami, FL, USA
| | - Diana M. Sheehan
- Research Center for Minority Institutions, Florida International University, Miami, FL, USA
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, Miami, FL, USA
| | - Mary Jo Trepka
- Research Center for Minority Institutions, Florida International University, Miami, FL, USA
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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Valerio LA, Rzepka MC, Davy-Mendez T, Williams A, Perhac A, Napravnik S, Berkowitz SA, Farel CE, Durr AL. Food Insecurity Prevalence and Risk Factors among Persons with HIV in a Southeastern US Clinical Care Setting. AIDS Behav 2024:10.1007/s10461-024-04497-7. [PMID: 39266889 DOI: 10.1007/s10461-024-04497-7] [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: 08/29/2024] [Indexed: 09/14/2024]
Abstract
Food insecurity (FI) is associated with adverse health outcomes for persons with HIV (PWH). Little is known about FI among PWH in southern or non-urban settings. We examined FI prevalence, risk factors, and access to services in a southeastern HIV clinic. Among PWH in the UNC CFAR HIV Clinical Cohort who were screened for FI as part of HIV care between 2021 and 2022, we estimated unadjusted prevalence ratios (PRs) comparing the probability of reporting FI by demographic and clinical characteristics. The 479 PWH screened for FI were 65% cisgender men, 62% non-Hispanic Black PWH, a median of 54 years old (IQR 41-62), and 93% with an HIV viral load (VL) < 200 copies/mL. FI prevalence was 36.3% (95% CI 32.3%-40.9%). Cisgender women and transgender adults were more likely to report FI than cisgender men (PRs 1.24 [95% CI 0.97-1.59] and 2.03 [1.32-3.12], respectively). Compared with White PWH, the PR was 1.71 (1.20-2.42) for Black and 2.44 (1.56-3.82) for Hispanic PWH. The PR was 1.42 (0.98-2.05) for PWH with VL ≥ 200 versus < 200 copies/mL. Having no or public versus private health insurance was also associated with FI. PWH with FI had a high prevalence of comorbidities including hypercholesterolemia (49%) and hypertension (48%), though these were not associated with FI. Almost half of PWH with FI were not accessing a food pantry or nutrition assistance program. Identifying FI in PWH is critical as FI is common and may contribute to viral non-suppression, poor comorbidity control, and gender and racial/ethnic health disparities in PWH.
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Affiliation(s)
- Lara A Valerio
- UNC Medical Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- , 100 Eastowne Drive, Chapel Hill, NC, 27514, USA.
| | | | - Thibaut Davy-Mendez
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexia Williams
- UNC Medical Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Angela Perhac
- UNC Medical Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Claire E Farel
- UNC Medical Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amy L Durr
- UNC Medical Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Derose KP, Palar K, Then-Paulino A, Han B, Armenta G, Celeste-Villalvir A, Sheira L, Jimenez-Paulino G, Acevedo R, Donastorg Y, Farías H, Wagner G. Changes in HIV Internalized and Experienced Stigmas and Social Support After an Urban Gardens and Peer Nutritional Counseling Intervention Among People With HIV and Food Insecurity in the Dominican Republic. J Acquir Immune Defic Syndr 2024; 97:55-62. [PMID: 39116332 PMCID: PMC11315355 DOI: 10.1097/qai.0000000000003462] [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: 11/07/2023] [Accepted: 04/22/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Food insecurity and HIV-related stigma negatively affect HIV outcomes. Few studies have examined how food security interventions affect HIV-related stigma and social support. SETTING Two HIV clinics in the Dominican Republic. METHODS A pilot cluster randomized controlled trial of an urban gardens and peer nutritional counseling intervention was conducted to examine outcomes of HIV-related stigmas and social support. Adult patients (≥18 years of age) with moderate or severe household food insecurity and evidence of suboptimal ART adherence and/or a detectable viral load were enrolled; standard measures of internalized and experienced stigmas and social support were collected at baseline and at 6 and 12 months. Intervention clinic participants received training and materials from agronomists for a home garden, 3-4 sessions of nutritional counseling from the clinic's peer counselor, and a garden produce cooking workshop facilitated by professional nutritionists. RESULTS Of 109 study participants (46 intervention and 63 control), 103 (94%) completed 12-month follow-up. Difference-in-differences multivariate longitudinal linear regressions adjusting for sociodemographic factors found that intervention participants had reduced internalized stigma by 3.04 points (scale 0-32) at 12 months (P = 0.002); reduced probability of experiencing HIV-related stigma or discrimination in the past 6 months (20 percentage points at 6 months, P = 0.05 and 25 percentage points at 12 months, P = 0.02); and modestly improved social support at 12 months (1.85 points on 30-pt scale, P = 0.093). CONCLUSION A fully powered, larger trial is needed to establish the efficacy of the intervention and assess pathways by which the intervention may improve HIV stigma and social support.
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Affiliation(s)
- Kathryn P. Derose
- University of Massachusetts Amherst, Department of Health Promotion and Policy, 715 N. Pleasant Street Amherst, MA 01003
- RAND Corporation and Pardee RAND Graduate School, 1776 Main Street, Santa Monica, California 90401
| | - Kartika Palar
- University of California, San Francisco, Department of Medicine, 505 Parnassus Ave, San Francisco, CA 94143
| | - Amarilis Then-Paulino
- Universidad Autónoma de Santo Domingo, Facultad de Ciencias de la Salud, Av. Alma Mater, Santo Domingo, Dominican Republic
| | - Bing Han
- RAND Corporation and Pardee RAND Graduate School, 1776 Main Street, Santa Monica, California 90401
| | - Gabriela Armenta
- RAND Corporation and Pardee RAND Graduate School, 1776 Main Street, Santa Monica, California 90401
| | - Alane Celeste-Villalvir
- University of Massachusetts Amherst, Department of Health Promotion and Policy, 715 N. Pleasant Street Amherst, MA 01003
| | - Lila Sheira
- University of California, San Francisco, Department of Medicine, 505 Parnassus Ave, San Francisco, CA 94143
| | - Gipsy Jimenez-Paulino
- Universidad Autónoma de Santo Domingo, Facultad de Ciencias de la Salud, Av. Alma Mater, Santo Domingo, Dominican Republic
| | - Ramón Acevedo
- Consejo Nacional de VIH/SIDA (CONAVIHSIDA), Santo Domingo, Dominican Republic
| | - Yeycy Donastorg
- Unidad de Vacunas e Investigación, Instituto Dermatológico, Dominicano y Cirugía de Piel Dr. Huberto Bogaert Diaz, Santo Domingo, Dominican Republic
| | - Hugo Farías
- World Food Programme, Regional Office for Latin America and the Caribbean, Panama City, Panama
| | - Glenn Wagner
- RAND Corporation and Pardee RAND Graduate School, 1776 Main Street, Santa Monica, California 90401
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Richterman A, Saintilien E, St-Cyr M, Claudia Gracia L, Sauer S, Pierre I, Compere M, Elnaiem A, Dumerjuste D, Ivers LC. Food Insecurity at Tuberculosis Treatment Initiation Is Associated With Clinical Outcomes in Rural Haiti: A Prospective Cohort Study. Clin Infect Dis 2024; 79:534-541. [PMID: 38888419 DOI: 10.1093/cid/ciae252] [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] [Received: 02/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Tuberculosis is a leading cause of death worldwide, and food insecurity is known to negatively influence health outcomes through multiple pathways. Few studies have interrogated the relationship between food insecurity and tuberculosis outcomes, particularly independent of nutrition. METHODS We conducted a prospective cohort study of adults initiating first-line treatment for clinically suspected or microbiologically confirmed drug-sensitive tuberculosis at a rural referral center in Haiti. We administered a baseline questionnaire, collected clinical data, and analyzed laboratory samples. We used logistic regression models to estimate the relationship between household food insecurity (Household Hunger Scale) and treatment failure or death. We accounted for exclusion of patients lost to follow-up using inverse probability of censoring weighting and adjusted for measured confounders and nutritional status using inverse probability of treatment weighting. RESULTS We enrolled 257 participants (37% female) between May 2020 and March 2023 with a median age (interquartile range) of 35 (25-45) years. Of these, 105 (41%) had no hunger in the household, 104 (40%) had moderate hunger in the household, and 48 (19%) had severe hunger in the household. Eleven participants (4%) died, and 6 (3%) had treatment failure. After adjustment, food insecurity was significantly associated with subsequent treatment failure or death (odds ratio 5.78 [95% confidence interval, 1.20-27.8]; P = .03). CONCLUSIONS Household food insecurity at tuberculosis treatment initiation was significantly associated with death or treatment failure after accounting for loss to follow-up, measured confounders, and nutritional status. In addition to the known importance of undernutrition, our findings indicate that food insecurity independently affects tuberculosis treatment outcomes in Haiti.
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Affiliation(s)
- Aaron Richterman
- Department of Medicine (Infectious Diseases), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elie Saintilien
- Tuberculosis Program, Health Equity International/St Boniface Hospital, Fond-des-Blancs, Haiti
| | - Medgine St-Cyr
- Tuberculosis Program, Health Equity International/St Boniface Hospital, Fond-des-Blancs, Haiti
| | - Louise Claudia Gracia
- Tuberculosis Program, Health Equity International/St Boniface Hospital, Fond-des-Blancs, Haiti
| | - Sara Sauer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Inobert Pierre
- Tuberculosis Program, Health Equity International/St Boniface Hospital, Fond-des-Blancs, Haiti
| | - Moise Compere
- Tuberculosis Program, Health Equity International/St Boniface Hospital, Fond-des-Blancs, Haiti
| | - Ahmed Elnaiem
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Dyemy Dumerjuste
- Tuberculosis Program, Health Equity International/St Boniface Hospital, Fond-des-Blancs, Haiti
| | - Louise C Ivers
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
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Abdulai K, Torpey K, Kotoh AM, Laar A. Associated factors of diet quality among people living with HIV/AIDS in Ghana. BMC Nutr 2024; 10:90. [PMID: 38907324 PMCID: PMC11193199 DOI: 10.1186/s40795-024-00898-y] [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: 09/14/2023] [Accepted: 06/19/2024] [Indexed: 06/23/2024] Open
Abstract
INTRODUCTION Nutrition is a very important element of a comprehensive care for people living with HIV/AIDS (PLHIV), especially in resource-constrained settings where malnutrition and food insecurity are common. Dietary diversity is a useful indication of nutritional adequacy (diet quality) in people of all ages. An optimally diverse diet strengthens the body's immune system. OBJECTIVE This study aimed to assess diet quality and its associated factors among PLHIV. METHODS A facility-based cross-sectional study design was employed to select 440 PLHIV from two hospitals in the Eastern Region of Ghana. Dietary intakes were determined using 24-hour recall. A stadiometer and bioimpedance analysis machine were used to obtain anthropometric and body composition data. Diet quality was assessed using FAO's individual dietary diversity score (IDDS) as a proxy. SPSS version 20 was used for analysis. Odds ratios and ordinal logistic regression were used to identify factors associated with diet quality among the PLHIV. P-value was set at 0.05. RESULTS Most of the PLHIV (73%) consumed from 'Starchy staple" food group. Less than 20% of the study sample consumed 'Fruits' and 'Vegetables' (17% and 14% respectively) a day before the survey. The mean IDDS was 4.11 (SD = 1.29). Overall, most of the PLHIV (56%) had medium IDDS which is equivalent to "diet needing improvement', 14% had higher IDDS (good diet), whiles about 31% of the participants actually had poor diet (lower IDDS). Associated factors of diet quality were age (AOR = 0.966: 95%CI: 0.936-0.997: p = 0.031), married (AOR = 4.634: 95%CI: 1.329-16.157: p = 0.0016), separated (AOR = 0.0203: 95%CI: .036-0.994: p = 0.049), and daily meal frequency (AOR = 0.441: 95%CI: .478-1.948: p = 0.020). Overall, the model accounts for about 20% of the variation in diet quality of the participants (pseudo-R square = 0.196). CONCLUSION This study demonstrates that most of the PLHIV did not consume good diet which may have an implication on their immune system, which is already under attack by HIV, and probably emerging infections. Age, marital status, and meal frequency were the variables that predicted diet quality among the study participants.
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Affiliation(s)
- Kasim Abdulai
- Translational Nutrition Research Group, Department of Clinical Nutrition and Dietetics, University of Cape Coast, Cape Coast, Ghana.
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Agnes Millicent Kotoh
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
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Nicol E, Jama NA, Mehlomakulu V, Hlongwa M, Pass D, Basera W, Bradshaw D. Enhancing linkage to HIV care in the "Universal Test and Treat" era: Barriers and enablers to HIV care among adults in a high HIV burdened district in KwaZulu-Natal, South Africa. BMC Public Health 2023; 23:1756. [PMID: 37689667 PMCID: PMC10492313 DOI: 10.1186/s12889-023-16576-w] [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: 04/04/2023] [Accepted: 08/21/2023] [Indexed: 09/11/2023] Open
Abstract
Ending AIDS by 2030 would depend on how successful health systems are in linking people living with HIV (PLHIV) into care. The World Health Organization recommended the 'Universal Test and Treat' (UTT) strategy - initiating all individuals testing positive on antiretroviral therapy (ART) irrespective of their CD4 count and clinical staging. This study aimed to explore the enablers and barriers to linkage to HIV care among adults with a new HIV diagnosis in a high-HIV prevalent rural district in South Africa. A qualitative study was undertaken to explore patients' perceptions of enablers and barriers of linkage-to-care, using a life-story narration and dialogue approach. In-depth interviews were conducted with 38 HIV-positive participants sampled from a cohort of 1194 HIV-positive patients recruited from December 2017 to June 2018. Participants were selected based on whether they had been linked to care or not within 3 months of positive HIV diagnosis. Interviews were thematically analysed using a general inductive approach. Of the 38 participants, 22 (58%) linked to care within three months of HIV-positive diagnosis. Factors that facilitated or inhibited linkage-to-care were found at individual, family, community, as well as health systems levels. Enablers included a positive HIV testing experience, and assistance from the fieldwork team. Support from family, and friends, as well as prior community-based education about HIV and ART were also noted. Individual factors such as acceptance of HIV status, previous exposure to PLHIV, and fear of HIV progressing, were identified. Barriers to linkage included, denial of HIV status, dislike of taking pills, and preference for alternative medicine. Negative experiences with counselling and health systems inefficiency were also noted as barriers. Perceived stigma and socio-economic factors, such as lack of food or money to visit the clinic were other barriers. Community-based and health system-level interventions would need to focus on clinic readiness in providing patients with necessary and effective health services such as proper and adequate counselling. This could increase the number of patients who link to care. Finally, interventions to improve linkage-to-care should consider a holistic approach, including training healthcare providers, community outreach and the provision of psychological, social, and financial support.
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Affiliation(s)
- Edward Nicol
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, TygerbergCape Town, 7505, South Africa.
- Division of Health Systems and Public Health, Stellenbosch University, Cape Town, South Africa.
| | - Ngcwalisa Amanda Jama
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, TygerbergCape Town, 7505, South Africa
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Vuyelwa Mehlomakulu
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, TygerbergCape Town, 7505, South Africa
| | - Mbuzeleni Hlongwa
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, TygerbergCape Town, 7505, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Public Health, Societies and Belonging, Human Sciences Research Council, Pretoria, South Africa
| | - Desiree Pass
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, TygerbergCape Town, 7505, South Africa
| | - Wisdom Basera
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, TygerbergCape Town, 7505, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, TygerbergCape Town, 7505, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Abioye AI, Hughes MD, Sudfeld CR, Noor RA, Isanaka S, Lukmanji Z, Mugusi F, Fawzi WW. Dietary Iron Intake and HIV-Related Outcomes Among Adults Initiating Antiretroviral Therapy in Tanzania. J Acquir Immune Defic Syndr 2023; 94:57-65. [PMID: 37199401 PMCID: PMC10524611 DOI: 10.1097/qai.0000000000003221] [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: 06/21/2022] [Accepted: 12/19/2022] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Anemia is highly prevalent among people living with HIV (PLWHIV) and is often due to iron deficiency. This study evaluated the relationship of dietary iron intake levels and sources with mortality and clinical outcomes among adults initiating HAART. DESIGN We conducted a secondary analysis of a multivitamin supplementation trial among 2293 PLWHIV initiating HAART in Dar es Salaam, Tanzania. METHODS Dietary iron intake was assessed with a food frequency questionnaire at HAART initiation, and participants followed until death or censoring. Total, animal-, and plant-sourced iron were categorized into quartiles. Intake of food groups was categorized into 0-1, 2-3, and ≥4 servings/wk. Cox proportional hazards models estimated hazard ratios for mortality and incident clinical outcomes. RESULTS There were 175 deaths (8%). Red meat intake was associated with a lower risk of all-cause mortality (HR: 0.54; 95% CI: 0.35 to 0.83), AIDS-related mortality (HR: 0.49; 95% CI: 0.28 to 0.85), and severe anemia (HR: 0.57; 95% CI: 0.35 to 0.91), when intake ≥4 servings/wk, compared with 0-1 servings/wk. Legume intake was a lower risk of associated with all-cause mortality (HR: 0.49; 95% CI: 0.31 to 0.77) and AIDS-related mortality (HR: 0.37; 95% CI: 0.23 to 0.61), when intake ≥4 servings/wk, compared with 0-1 servings/wk. Although total dietary iron and overall plant-sourced iron intake were not associated with the risk of mortality or HIV-related outcomes, the highest quartile of animal-sourced iron intake was associated with a lower risk of all-cause mortality (HR: 0.56; 95% CI: 0.35 to 0.90) and a lower risk of AIDS-related mortality (HR: 0.50; 95% CI: 0.30 to 0.90), compared with the lowest quartile. CONCLUSION Intake of iron-rich food groups may be associated with a lower risk of mortality and critical HIV-related outcomes among adults initiating HAART. TRIAL REGISTRATION The parent trial was registered at Clinicaltrials.gov . Identifier: NCT00383669.
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Affiliation(s)
| | | | - Christopher R Sudfeld
- Departments of Nutrition
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Sheila Isanaka
- Departments of Nutrition
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Ferdinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; and
| | - Wafaie W Fawzi
- Departments of Nutrition
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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Bleasdale J, Liu Y, Leone LA, Morse GD, Przybyla SM. The impact of food insecurity on receipt of care, retention in care, and viral suppression among people living with HIV/AIDS in the United States: a causal mediation analysis. Front Public Health 2023; 11:1133328. [PMID: 37601182 PMCID: PMC10433761 DOI: 10.3389/fpubh.2023.1133328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Attaining The Joint United Nations Programme on HIV/AIDS 95-95-95 targets to end the HIV epidemic by 2030 will require a greater understanding of the underlying mechanisms influencing care engagement among people living with HIV/AIDS (PLWHA). One such mechanism is food insecurity, defined as limited or uncertain access to food. Food insecurity has been shown to significantly impact HIV outcomes. Yet, few studies have examined the mechanisms through which food insecurity may influence these outcomes. We aimed to examine the effects of nutritional, behavioral, and mental health mechanisms through which food insecurity may impact HIV care continuum outcomes: receipt of care, retention in care, and viral suppression. Methods We conducted a cross-sectional study of 200 PLWHA in New York State, United States from May-August 2022. Participants were recruited using convenience sampling methods. Multivariable logistic regression models were conducted to examine the associations between food insecurity and care continuum outcomes (receipt of care, retention in care, viral suppression), adjusting for age, race, ethnicity, education, income, and marital status. Individual causal mediation analyses were conducted to assess whether behavioral, mental health, and nutritional mechanisms mediated the hypothesized associations. Results The median age of participants was 30 years (IQR: 27-37 years). The majority self-identified as Black (54.0%), male (55.5%) and straight/heterosexual (63.0%). Increasing severity of food insecurity was associated with greater odds of non-retention in care (aOR: 1.35, 95% CI: 1.07, 1.70) and viral non-suppression (aOR: 1.29, 95% CI: 1.08, 1.54). For the impact of food insecurity on non-retention in care, there was an indirect relationship (natural indirect effect; NIE) mediated through Body Mass Index (BMI) (ORNIE: 1.08, 95% CI: 1.00, 1.18). For viral non-suppression, there was an indirect relationship mediated through BMI (ORNIE: 1.07, 95% CI: 1.00,1.16) and an indirect relationship mediated through depression (ORNIE: 1.27, 95% CI: 1.07, 1.47). Discussion Food insecurity was associated with greater odds of non-retention in care and viral non-suppression among PLWHA. Nutritional and mental health pathways are important mediators of these relationships. Results highlight the need for interventions to target these pathways to address food insecurity as an underlying mechanism influencing engagement in HIV care.
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Affiliation(s)
- Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
| | - Yu Liu
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
| | - Gene D. Morse
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
- Center for Integrated Global Biomedical Sciences, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Sarahmona M. Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
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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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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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Implementation of a Novel Clinic/Community Partnership Addressing Food Insecurity Among Adults With HIV in the Southern United States: A Program Brief. J Assoc Nurses AIDS Care 2023; 34:307-315. [PMID: 36897568 DOI: 10.1097/jnc.0000000000000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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12
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Drought, HIV Testing, and HIV Transmission Risk Behaviors: A Population-Based Study in 10 High HIV Prevalence Countries in Sub-Saharan Africa. AIDS Behav 2023; 27:855-863. [PMID: 36066761 DOI: 10.1007/s10461-022-03820-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/01/2022]
Abstract
Droughts are associated with poor health outcomes and disruption of public health programming. Data on the association between drought and HIV testing and transmission risk behaviors are limited. We combined data from Demographic and Health Surveys from 10 high HIV prevalence sub-Saharan African countries with a high-resolution measure of drought. We estimated the association between drought and recent HIV testing, report of condomless sex, and number of sexual partners in the last year. Respondents exposed to drought were less likely to have an HIV test and more likely to have condomless sex, although effect sizes were small. We found evidence for effect modification by sex and age for the association between drought and HIV testing, such that the negative association between drought and HIV testing was strongest among men (marginal risk ratio [mRR] 0.92, 95% CI 0.89-0.95) and adolescents (mRR 0.90, 95% CI 0.86-0.93). Drought may hinder HIV testing programs in countries with high HIV prevalence.
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Derose KP, Then-Paulino A, Han B, Armenta G, Palar K, Jimenez-Paulino G, Sheira LA, Acevedo R, Fulcar MA, Lugo Bernard C, Veloz Camacho I, Donastorg Y, Wagner GJ. Preliminary Effects of an Urban Gardens and Peer Nutritional Counseling Intervention on HIV Treatment Adherence and Detectable Viral Load Among People with HIV and Food Insecurity: Evidence from a Pilot Cluster Randomized Controlled Trial in the Dominican Republic. AIDS Behav 2023; 27:864-874. [PMID: 36066760 PMCID: PMC9446649 DOI: 10.1007/s10461-022-03821-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/01/2022]
Abstract
A pilot cluster randomized controlled trial involving two HIV clinics in the Dominican Republic assessed preliminary efficacy of an urban garden and peer nutritional counseling intervention. A total of 115 participants (52 intervention, 63 control) with moderate or severe food insecurity and sub-optimal antiretroviral therapy (ART) adherence and/or detectable viral load were assessed at baseline, 6- and 12-months. Longitudinal multivariate regression analysis controlling for socio-demographics and accounting for serial cluster correlation found that the intervention: reduced the prevalence of detectable viral load by 20 percentage points at 12 months; reduced any missed clinic appointments by 34 and 16 percentage points at 6 and 12 months; increased the probability of "perfect" ART adherence by 24 and 20 percentage points at 6 and 12 months; and decreased food insecurity at 6 and 12 months. Results are promising and warrant a larger controlled trial to establish intervention efficacy for improving HIV clinical outcomes.Trial registry Clinical Trials Identifier: NCT03568682.
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Affiliation(s)
- Kathryn P Derose
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA, USA.
- Department of Health Promotion and Policy, University of Massachusetts Amherst, 715 N. Pleasant St., Amherst, MA, 01003, USA.
| | - Amarilis Then-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
- Ministerio de Salud Pública, Santo Domingo, Dominican Republic
| | - Bing Han
- Economics, Sociology, & Statistics Department, RAND Corporation, Santa Monica, CA, USA
- Division of Biostatistics Research, Department of Research & Evaluations, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Gabriela Armenta
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, CA, USA
| | - Kartika Palar
- Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Gipsy Jimenez-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Lila A Sheira
- Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Ramón Acevedo
- Consejo Nacional para el VIH y Sida (CONAVIHSIDA), Santo Domingo, Dominican Republic
| | - María A Fulcar
- World Food Programme, Country Office for the Dominican Republic, Santo Domingo, Dominican Republic
| | - Claudio Lugo Bernard
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Isidro Veloz Camacho
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Yeycy Donastorg
- Unidad de Vacunas e Investigación, Instituto Dermatológico Dominicano y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Glenn J Wagner
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA, USA
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Beyene SD. The impact of food insecurity on health outcomes: empirical evidence from sub-Saharan African countries. BMC Public Health 2023; 23:338. [PMID: 36793014 PMCID: PMC9930357 DOI: 10.1186/s12889-023-15244-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Food insecurity adversely affects human health, which means food security and nutrition are crucial to improving people's health outcomes. Both food insecurity and health outcomes are the policy and agenda of the 2030 Sustainable Development Goals (SDGs). However, there is a lack of macro-level empirical studies (Macro-level study means studies at the broadest level using variables that represent a given country or the whole population of a country or economy as a whole. For example, if the urban population (% of the total population) of XYZ country is 30%, it is used as a proxy variable to represent represent country's urbanization level. Empirical study implies studies that employ the econometrics method, which is the application of math and statistics.) concerning the relationship between food insecurity and health outcomes in sub-Saharan African (SSA) countries though the region is highly affected by food insecurity and its related health problems. Therefore, this study aims to examine the impact of food insecurity on life expectancy and infant mortality in SSA countries. METHODS The study was conducted for the whole population of 31 sampled SSA countries selected based on data availability. The study uses secondary data collected online from the databases of the United Nations Development Programme (UNDP), the Food and Agricultural Organization (FAO), and the World Bank (WB). The study uses yearly balanced data from 2001 to 2018. This study employs a multicountry panel data analysis and several estimation techniques; it employs Driscoll-Kraay standard errors (DKSE), a generalized method of momentum (GMM), fixed effects (FE), and the Granger causality test. RESULTS A 1% increment in people's prevalence for undernourishment reduces their life expectancy by 0.00348 percentage points (PPs). However, life expectancy rises by 0.00317 PPs with every 1% increase in average dietary energy supply. A 1% rise in the prevalence of undernourishment increases infant mortality by 0.0119 PPs. However, a 1% increment in average dietary energy supply reduces infant mortality by 0.0139 PPs. CONCLUSIONS Food insecurity harms the health status of SSA countries, but food security impacts in the reverse direction. This implies that to meet SDG 3.2, SSA should ensure food security.
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Affiliation(s)
- Sisay Demissew Beyene
- College of Business and Economics, Department of Economics, Arsi University, Asella, Ethiopia.
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15
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Vander-Pallen R, Domfeh EA, Hayford FEA, Asante M, Amoah AGB, Asare GA, Wiredu EK. Nutritional status and effect of highly active anti-retroviral therapy (HAART) on selected trace elements in people living with HIV in Ghana. SCIENTIFIC AFRICAN 2023. [DOI: 10.1016/j.sciaf.2023.e01586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
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16
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Daniel AK, Dworkin SL, McDonough A, Hatcher AM, Burger RL, Weke E, Wekesa P, Bukusi EA, Owino G, Odhiambo G, Thirumurthy H, Getahun M, Weiser SD, Cohen CR. The Impact of Land Tenure Security on a Livelihood Intervention for People Living with HIV in Western Kenya. AIDS Behav 2023; 27:245-256. [PMID: 35930199 PMCID: PMC9851924 DOI: 10.1007/s10461-022-03760-z] [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: 06/15/2022] [Indexed: 01/24/2023]
Abstract
Few studies have explored land access, a structural driver of health, and women's participation in livelihood interventions to improve food security and HIV outcomes. This qualitative study, embedded within Shamba Maisha (NCT02815579)-a randomized controlled trial (RCT) examining the impact of a multisectoral intervention among farmers living with HIV in western Kenya-sought to explore the influence of perceived access to and control of land on agricultural productivity, investments, and benefits. Thirty in-depth interviews (IDIs) were conducted with purposively sampled men and women, 3 to 6 months after receiving intervention inputs; data were deductively and inductively coded and analyzed. Farming practices and participation in Shamba Maisha were dependent on land tenure and participants' perceived strength of claim over their land, with participants who perceived themselves to be land insecure less likely to make long-term agricultural investments. Land tenure was influenced by a number of factors and posed unique challenges for women which negatively impacted uptake and success in the intervention. Data underscore the importance of secure land tenure for the success of similar interventions, especially for women; future interventions should integrate land security programming for improved outcomes for all.
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Affiliation(s)
- Afkera K Daniel
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA.
| | - Shari L Dworkin
- School of Nursing and Health Studies, University of Washington, Bothell, Bothell, WA, USA
| | - Annie McDonough
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Abigail M Hatcher
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Rachel L Burger
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - George Owino
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Gladys Odhiambo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Harsha Thirumurthy
- Department of Medical Ethics and Heath Policy, Perelman School of Medicine, Philadelphia, PA, USA
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
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17
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Nicastro TM, Pincus L, Weke E, Hatcher AM, Burger RL, Lemus-Hufstedler E, Bukusi EA, Cohen CR, Weiser SD. Perceived impacts of a pilot agricultural livelihood and microfinance intervention on agricultural practices, food security and nutrition for Kenyans living with HIV. PLoS One 2022; 17:e0278227. [PMID: 36516159 PMCID: PMC9749965 DOI: 10.1371/journal.pone.0278227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/12/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Agriculture is the primary source of income and household food for >75% of rural Kenyans, including people living with HIV (PLHIV), making agricultural yields an important factor in food security and nutrition. Previous studies have shown the interconnectedness of food insecurity, malnutrition, and poor HIV health by elucidating that having one of these conditions increases the likelihood and severity of having another. However, few studies have explored the linkages between agricultural practices, food security and nutrition for PLHIV, or how agricultural livelihood interventions may affect these domains. This study aimed to examine the mechanisms through which an agricultural livelihood intervention can positively or negatively affect agricultural practices, food security, and nutrition for PLHIV. METHODS From July 2012-August 2013, we interviewed participants with HIV on antiretroviral therapy (ART) enrolled in a pilot randomized controlled trial (RCT) of an agricultural livelihood and finance intervention to understand the mechanisms through which the intervention may have affected HIV health outcomes. The intervention included agricultural and finance training and a microfinance loan to purchase the MoneyMaker hip pump, a human-powered water pump, seeds, and other farming implements. A purposive sample of 45 intervention and a random subset of 9 control participants were interviewed at 12-month endline visit with a subset of 31 intervention participants interviewed longitudinally at both the 3- and 12-month visits. Transcripts were double coded using an inductive-deductive approach and analyzed for impacts of the intervention on agricultural practices, food security, and nutrition using analytic reports for each key theme. RESULTS All intervention participants described improvements in agricultural practices and yields attributed to the intervention while many also described improvements in income; these changes in turn contributed to improved HIV health, including suppressed viral loads, and a few people noted improved immunologic parameters. Key mechanisms included the knowledge gained from agricultural training which led to improved yields and access to new markets. The use of the irrigation pump was also identified as an additional, lesser important mechanism. All intervention participants reported sustained improvements in food security and nutrition through increased yields and income from the sale of excess crops used to purchase food, and diversification of fresh fruits and vegetables consumed through agricultural production. This led to self-reported weight gain which was a nutritional mechanism towards improved health. CONCLUSIONS Agricultural and finance interventions that improve farming practices could lead to improved health outcomes through the pathways of improved food security, income, and diversified diet. The results from this study helped the team to enhance the intervention prior to implementation of the larger cluster RCT (cRCT). By understanding how agricultural livelihood interventions act upon pathways towards improved health, policy options can be developed and implemented to include components that are needed to achieve sustainable outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT01548599.
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Affiliation(s)
- Tammy M. Nicastro
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Lauren Pincus
- Independent Consultant, Washington, CT, United States of America
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Abigail M. Hatcher
- Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Rachel L. Burger
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Emiliano Lemus-Hufstedler
- School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Elizabeth A. Bukusi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, United States of America
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Sheri D. Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
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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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Derose KP, Han B, Armenta G, Palar K, Then-Paulino A, Jimenez-Paulino G, Sheira L, Acevedo R, Lugo C, Veloz I, Donastorg Y, Wagner G. Exploring antiretroviral therapy adherence, competing needs, and viral suppression among people living with HIV and food insecurity in the Dominican Republic. AIDS Care 2022; 34:1234-1242. [PMID: 34581230 PMCID: PMC8958167 DOI: 10.1080/09540121.2021.1981218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 09/09/2021] [Indexed: 01/26/2023]
Abstract
Understanding factors related to suboptimal adherence to antiretroviral therapy (ART) and detectable viral load (VL), especially among vulnerable populations, is needed to improve HIV outcomes. The Caribbean is highly impacted by HIV and socioeconomic inequalities, but few studies have been conducted there to explore food insecurity among people with HIV and factors associated with viral suppression in this vulnerable population. Using baseline data from a pilot intervention trial among people living with HIV and food insecurity in the Dominican Republic, we examined psychosocial and behavioral factors associated with viral suppression, ART adherence, and competing needs. Among participants (n = 115), 61% had a detectable VL; the strongest factor associated with detectable VL was having missed taking ART in the last six months due to not having food (OR = 2.68, p = 0.02). Greater odds of reporting missed ART doses due to not having food were associated with severe food insecurity (OR = 4.60, p = 0.006), clinical depression (OR = 2.76, p = 0.018), Haitian background (OR = 6.62 p = 0.017), and internalized HIV stigma (OR = 1.09, p = 0.041), while lower odds were associated with social support (OR = 0.89, p = 0.03) and having health insurance (OR = 0.27, p = 0.017). Ensuring that people with HIV and food insecurity have food to take with their ART is essential for viral suppression.
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Affiliation(s)
- Kathryn P. Derose
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA
- Department of Health Promotion and Policy, University of Massachusetts, Amherst
| | - Bing Han
- Economics, Sociology, & Statistics Department, RAND Corporation, Santa Monica, CA
| | | | - Kartika Palar
- Division of HIV, ID and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - Amarilis Then-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
- Ministerio de Salud Pública, Santo Domingo, Dominican Republic
| | - Gipsy Jimenez-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Lila Sheira
- Division of HIV, ID and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - Ramón Acevedo
- Consejo Nacional para el VIH y Sida (CONAVIHSIDA), Santo Domingo, Dominican Republic
| | - Claudio Lugo
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Isidro Veloz
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Yeycy Donastorg
- Unidad de Vacunas e Investigación, Instituto Dermatológico Dominicano y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Glenn Wagner
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA
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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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21
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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: 3] [Impact Index Per Article: 1.5] [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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22
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Assessing the Health Outcomes of the Food Access Pilot Project: An Evaluation of a Medically Supportive Food Support Program for People Living with HIV in Rural California Counties. AIDS Behav 2022; 26:2613-2622. [PMID: 35122577 PMCID: PMC9252945 DOI: 10.1007/s10461-022-03589-6] [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] [Accepted: 01/15/2022] [Indexed: 11/08/2022]
Abstract
Food insecurity disproportionately affects rural communities and people living with HIV (PLHIV). The Food Access Pilot Project (FAPP) was a California state-funded program that provided home-delivered, medically supportive meals via online meal vendors to food-insecure PLHIV in three rural counties. We performed longitudinal, retrospective analyses of FAPP participant data (n = 158; 504 and 460 person-time observations for viral load and CD4 count, respectively) over 36 months from a Ryan White client management database. Pre-post analyses demonstrated increased prevalence of food security and CD4 ≥ 500 between baseline and 12 months. Population-averaged trends using generalized estimating equations adjusted for participant demographics demonstrated increased odds of viral suppression and CD4 ≥ 500, and increased CD4 count (cells/mm3) for every six months of program enrollment. Home-delivered, medically supportive meals may improve food security status, HIV viral suppression, and immune health for low-income PLHIV in rural settings.
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23
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Kalichman SC, El-Krab R. Social and Behavioral Impacts of COVID-19 on People Living with HIV: Review of the First Year of Research. Curr HIV/AIDS Rep 2022; 19:54-75. [PMID: 34826067 PMCID: PMC8617547 DOI: 10.1007/s11904-021-00593-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF THE REVIEW The SARS-CoV-2 (COVID-19) pandemic brought unprecedented social change with the most severe impacts on the most vulnerable populations, including people living with HIV (PLWH). This review examined findings from empirical studies of social and behavioral impacts of COVID-19 on PLWH in the first year of the pandemic. RECENT FINDINGS Impacts of COVID-19 on PLWH fit within an HIV syndemics framework, with overlapping COVID-19 and HIV comorbid conditions concerning mental health and structural inequality. Early impacts of COVID-19 on social isolation, emotional distress, stigma, and substance use varied across studies with few consistent patterns. Structural inequalities, particularly impacts on food security and housing stability, were observed more consistently and globally. COVID-19 intersects with HIV infection along with multiple interlocking comorbidities that are best characterized and understood within a syndemics framework.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration On Health Intervention and Policy, University of Connecticut, 2006 Hillside Road, Storrs, CT, 06269, USA.
| | - Renee El-Krab
- Institute for Collaboration On Health Intervention and Policy, University of Connecticut, 2006 Hillside Road, Storrs, CT, 06269, USA
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24
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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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25
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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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26
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Richterman A, Block JP, Tsai AC, Ivers LC. Supplemental Nutrition Assistance Program Eligibility and HIV Incidence in the United States. Open Forum Infect Dis 2021; 8:ofab101. [PMID: 34409118 PMCID: PMC8368054 DOI: 10.1093/ofid/ofab101] [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: 12/08/2020] [Accepted: 03/02/2021] [Indexed: 12/01/2022] Open
Abstract
Background The connection between food insecurity and HIV outcomes is well established. The Supplemental Nutrition Assistance Program (SNAP), the primary food safety net program in the United States, may have collateral impacts on HIV incidence. “Broad-based categorical eligibility” for SNAP is a policy that provides a mechanism for states to increase the income or asset limits for SNAP eligibility. Methods We estimated the association between the number of new HIV diagnoses in 2010–2014 for each state and (1) state income limits and (2) state asset limits for SNAP eligibility. We fitted multivariable negative binomial regression models with number of HIV diagnoses specified as the outcome; SNAP policies as the primary explanatory variable of interest; state and year fixed effects; and time-varying covariates related to the costs of food, health care, housing, employment, other SNAP policies, and Temporary Assistance for Needy Families spending. Results HIV diagnoses within states had a statistically significant association with state income limits for SNAP eligibility (incidence rate ratio [IRR], 0.94 per increase in the income limit by 35% of federal poverty level; 95% CI, 0.91–0.98), but no association with state asset limits (increased asset limit vs no change: IRR, 1.02; 95% CI, 0.94–1.10; eliminated asset limit vs no change: IRR, 1.04; 95% CI, 0.99–1.10). Conclusions State income limits for SNAP eligibility were inversely associated with the number of new HIV diagnoses for states between 2010 and 2014. Proposals to eliminate the use of broad-based categorical eligibility to increase the income limit for SNAP may undercut efforts to end the HIV epidemic in the United States.
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Affiliation(s)
- Aaron Richterman
- Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason P Block
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Alexander C Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Louise C Ivers
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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27
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de Souza AMA, Ecelbarger CM, Sandberg K. Caloric Restriction and Cardiovascular Health: the Good, the Bad, and the Renin-Angiotensin System. Physiology (Bethesda) 2021; 36:220-234. [PMID: 34159807 DOI: 10.1152/physiol.00002.2021] [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: 12/26/2022] Open
Abstract
Much excitement exists over the cardioprotective and life-extending effects of caloric restriction (CR). This review integrates population studies with experimental animal research to address the positive and negative impact of mild and severe CR on cardiovascular physiology and pathophysiology, with a particular focus on the renin-angiotensin system (RAS). We also highlight the gaps in knowledge and areas ripe for future physiological research.
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Affiliation(s)
- Aline M A de Souza
- Division of Nephrology and Hypertension, Department of Medicine, Georgetown University, Washington, District of Columbia
| | - Carolyn M Ecelbarger
- Division of Nephrology and Hypertension, Department of Medicine, Georgetown University, Washington, District of Columbia
| | - Kathryn Sandberg
- Division of Nephrology and Hypertension, Department of Medicine, Georgetown University, Washington, District of Columbia
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28
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Derose KP, Fulcar MA, Acevedo R, Armenta G, Jiménez-Paulino G, Bernard CL, del Rosario LEP, Then-Paulino A. An Integrated Urban Gardens and Peer Nutritional Counseling Intervention to Address Food Insecurity Among People With HIV in the Dominican Republic. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:187-201. [PMID: 34014110 PMCID: PMC8274817 DOI: 10.1521/aeap.2021.33.3.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Food insecurity negatively affects HIV prevention and care, and sustainable interventions are needed. Here we describe the development of an integrated urban gardens and peer nutritional counseling intervention to address food insecurity and nutrition among people with HIV, which included: (1) peer nutritional counseling, (2) gardening training, and (3) garden-based nutrition and cooking workshops. The intervention was developed using community-based participatory research over multiple years and stages of data gathering and implementation and evaluation. Lessons learned include the importance of cross-sectoral partnerships to achieve multifaceted, integrated, and sustainable interventions and a shared commitment among partners to an ongoing cycle of action-oriented research, and the need for home-based and community-based gardens to enhance food security and social support. The development process successfully combined an evidence-based framework and community engagement to yield a multicomponent yet integrated food security and nutrition intervention appropriate for people with HIV and potentially adaptable for other chronic conditions.
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Affiliation(s)
- Kathryn P. Derose
- RAND Corporation, Santa Monica, CA, USA
- University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Ramón Acevedo
- Consejo Nacional para el VIH y Sida (CONAVIHSIDA), Santo Domingo, Dominican Republic
| | - Gabriela Armenta
- RAND Corporation, Santa Monica, CA, USA
- Pardee RAND Graduate School, Santa Monica, CA, USA
| | - Gipsy Jiménez-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Claudio Lugo Bernard
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | | | - Amarilis Then-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
- Ministerio de Salud Pública, Santo Domingo, Dominican Republic
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29
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Leddy AM, Zakaras JM, Shieh J, Conroy AA, Ofotokun I, Tien PC, Weiser SD. Intersections of food insecurity, violence, poor mental health and substance use among US women living with and at risk for HIV: Evidence of a syndemic in need of attention. PLoS One 2021; 16:e0252338. [PMID: 34038490 PMCID: PMC8153505 DOI: 10.1371/journal.pone.0252338] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Food insecurity and intimate partner violence (IPV) are associated with suboptimal HIV prevention and treatment outcomes, yet limited research has explored how food insecurity and IPV intersect to influence HIV-related behaviors. To fill this gap, we conducted a qualitative study with women living with or at risk for HIV in the United States. Methods We conducted 24 in-depth interviews with women enrolled in the San Francisco and Atlanta sites of the Women’s Interagency HIV study (WIHS). Participants were purposively sampled so half were living with HIV and all reported food insecurity and IPV in the past year. Semi-structured interviews explored experiences with food insecurity and IPV, how these experiences might be related and influence HIV risk and treatment behaviors. Analysis was guided by an inductive-deductive approach. Results A predominant theme centered on how food insecurity and IPV co-occur with poor mental health and substance use to influence HIV-related behaviors. Women described how intersecting experiences of food insecurity and IPV negatively affected their mental health, with many indicating using substances to “feel no pain”. Substance use, in turn, was described to perpetuate food insecurity, IPV, and poor mental health in a vicious cycle, ultimately facilitating HIV risk behaviors and preventing HIV treatment adherence. Conclusions Food insecurity, IPV, poor mental health and substance use intersect and negatively influence HIV prevention and treatment behaviors. Findings offer preliminary evidence of a syndemic that goes beyond the more widely studied “SAVA” (substance use, AIDS, and violence) syndemic, drawing attention to additional constructs of mental health and food insecurity. Quantitative research must further characterize the extent and size of this syndemic. Policies that address the social and structural drivers of this syndemic, including multi-level and trauma-informed approaches, should be implemented and evaluated to assess their impact on this syndemic and its negative health effects.
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Affiliation(s)
- Anna M Leddy
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Jennifer M Zakaras
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Jacqueline Shieh
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Amy A Conroy
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Ighovwerha Ofotokun
- School of Medicine, Emory University and Grady Healthcare System, Atlanta, GA, United States of America
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America.,Department of Veteran Affairs Medical Center, San Francisco, CA, United States of America
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
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30
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Patterson K, Berrang-Ford L, Lwasa S, Namanya DB, Ford J, Research Team IHACC, Harper SL. Food security variation among Indigenous communities in South-western Uganda. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021. [DOI: 10.1080/19320248.2020.1852146] [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)
- Kaitlin Patterson
- Dept. Of Population Medicine, University of Guelph, Guelph, Ontario, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta
| | - Lea Berrang-Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, UK
- Indigenous Health Adaptation to Climate Change Research Group, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Shuaib Lwasa
- Indigenous Health Adaptation to Climate Change Research Group, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Dept. Of Geography Geoinformatics and Climatic Sciences, Makerere University, Kampala, Uganda
| | - Didacus B. Namanya
- Indigenous Health Adaptation to Climate Change Research Group, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Ugandan Ministry of Health, Kampala, Uganda
| | - James Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, UK
- Indigenous Health Adaptation to Climate Change Research Group, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - IHACC Research Team
- Indigenous Health Adaptation to Climate Change Research Group, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Sherilee L. Harper
- Indigenous Health Adaptation to Climate Change Research Group, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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31
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Brown LB, Spinelli MA, Gandhi M. The interplay between HIV and COVID-19: summary of the data and responses to date. Curr Opin HIV AIDS 2021; 16:63-73. [PMID: 33186229 PMCID: PMC7735216 DOI: 10.1097/coh.0000000000000659] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW We examine the interplay between the HIV and COVID-19 epidemics, including the impact of HIV on COVID-19 susceptibility and severe disease, the effect of the COVID-19 epidemic on HIV prevention and treatment, and the influence of the HIV epidemic on responses to COVID-19. RECENT FINDINGS Evidence to date does not suggest that people living with HIV (PLWH) have a markedly higher susceptibility to SARS-CoV-2 infection, with disparities in the social determinants of health and comorbidities likely having a greater influence. The majority of literature has not supported a higher risk for severe disease among PLWH in Europe and the United States, although a large, population-based study in South Africa reported a higher rate of death due to COVID-19. Higher rates of comorbidities associated with COVID-19 disease severity among PLWH is an urgent concern. COVID-19 is leading to decreased access to HIV prevention services and HIV testing, and worsening HIV treatment access and virologic suppression, which could lead to worsening HIV epidemic control. CONCLUSION COVID-19 is threatening gains against the HIV epidemic, including the U.S. Ending the HIV Epidemic goals. The ongoing collision of these two global pandemics will continue to need both study and interventions to mitigate the effects of COVID-19 on HIV efforts worldwide.
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Affiliation(s)
- Lillian B. Brown
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
| | - Matthew A. Spinelli
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
| | - Monica Gandhi
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
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Kalichman SC, Kalichman MO, Banas E, Hill M, Katner H. Drug Use and Life Chaos as Potential Factors Contributing to HIV Viral Load among People with Lower Health Literacy. Subst Use Misuse 2021; 56:606-614. [PMID: 33648415 DOI: 10.1080/10826084.2021.1884722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Lower health literacy is associated with poorer health outcomes in people living with HIV (PLWH), but the explanatory mechanisms for these associations are not well understood. Factors such as drug use and life chaos may at least in part account for the relationship between lower health literacy and poor health outcomes. The current study tested the hypothesis that lower health literacy would predict drug use, which in turn would predict life chaos, and that all three factors would be related to poorer heath, defined by higher concentrations of HIV viremia. Methods: Patients receiving HIV care (N = 251) at an HIV clinic in the southeastern United States completed computerized interviews and permission to access their medical records. Process modeling tested direct and indirect effects of all variables in a serial mediation model. Results: The direct effects of lower health literacy and drug use were significantly related to HIV viremia. In addition, the indirect effect of health literacy on HIV viremia through drug use was significant. However, results did not demonstrate any effect, direct or indirect, of life chaos on HIV viremia. Conclusion: Findings from this study bolster previous research demonstrating lower health literacy and drug use as barriers to HIV care, and show that lower health literacy impacts HIV viremia, at least in part, through drug use. Interventions aimed to improve HIV treatment outcomes in lower health literacy populations may be enhanced by integrating evidence-based approaches to reducing drug use.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Moira O Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Ellen Banas
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
| | - Marnie Hill
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
| | - Harold Katner
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
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Peters BA, Sheira LA, Hanna DB, Qi Q, Sharma A, Adedimeji A, Wilson T, Merenstein D, Tien PC, Cohen M, Wentz EL, Kinslow J, Landay AL, Weiser SD. Food Insecurity and T-cell Dysregulation in Women Living With Human Immunodeficiency Virus on Antiretroviral Therapy. Clin Infect Dis 2020; 72:e112-e119. [PMID: 33247896 PMCID: PMC7935377 DOI: 10.1093/cid/ciaa1771] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/20/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Food insecurity is associated with increased morbidity and mortality in people with human immunodeficiency virus (HIV) on antiretroviral therapy, but its relationship with immune dysregulation, a hallmark of HIV infection and comorbidity, is unknown. METHODS In 241 women participating in the Women's Interagency HIV Study, peripheral blood mononuclear cells were characterized by flow cytometry to identify cell subsets, comprising surface markers of activation (%CD38+HLADR+), senescence (%CD57+CD28-), exhaustion (%PD-1+), and co-stimulation (%CD57- CD28+) on CD4+ and CD8+ T cells. Mixed-effects linear regression models were used to assess the relationships of food insecurity with immune outcomes, accounting for repeated measures at ≤3 study visits and adjusting for sociodemographic and clinical factors. RESULTS At the baseline study visit, 71% of participants identified as non-Hispanic Black, 75% were virally suppressed, and 43% experienced food insecurity. Food insecurity was associated with increased activation of CD4+ and CD8+ T cells, increased senescence of CD8+ T cells, and decreased co-stimulation of CD4+ and CD8+ T cells (all P < .05), adjusting for age, race/ethnicity, income, education, substance use, smoking, HIV viral load, and CD4 count. In stratified analyses, the association of food insecurity with CD4+ T-cell activation was more pronounced in women with uncontrolled HIV (viral load >40 copies/mL and CD4 <500 cells/mm3) but remained statistically significant in those with controlled HIV. CONCLUSIONS Food insecurity may contribute to the persistent immune activation and senescence in women with HIV on antiretroviral therapy, independently of HIV control. Reducing food insecurity may be important for decreasing non-AIDS-related disease risk in this population.
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Affiliation(s)
- Brandilyn A Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA,Correspondence: B. A. Peters, Assistant Professor of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, #1315AB Bronx, NY 10461 ()
| | - Lila A Sheira
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tracey Wilson
- Department of Community Health Sciences, SUNY Downstate Health Sciences University, School of Public Health, Brooklyn, New York, USA
| | - Daniel Merenstein
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Phyllis C Tien
- Department of Medicine, University of California San Francisco, San Francisco, California, USA,Department of Veterans Affairs Medical Center, San Francisco, California, USA
| | - Mardge Cohen
- Department of Medicine, Cook County Health and Hospital System, Chicago, Illinois, USA
| | - Eryka L Wentz
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer Kinslow
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Alan L Landay
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, California, USA,Department of Medicine, University of California San Francisco, San Francisco, California, USA,Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
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Leddy AM, Weiser SD, Palar K, Seligman H. A conceptual model for understanding the rapid COVID-19-related increase in food insecurity and its impact on health and healthcare. Am J Clin Nutr 2020; 112:1162-1169. [PMID: 32766740 PMCID: PMC7454255 DOI: 10.1093/ajcn/nqaa226] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/20/2020] [Indexed: 12/21/2022] Open
Abstract
Food insecurity, a well-established determinant of chronic disease morbidity and mortality, is rapidly increasing due to the coronavirus disease 2019 (COVID-19) pandemic. We present a conceptual model to understand the multiple mechanisms through which the economic and public health crises sparked by COVID-19 might increase food insecurity and contribute to poor health outcomes in the short- and long-term. We hypothesize that, in the short-term, increased food insecurity, household economic disruption, household stress, and interruptions in healthcare will contribute to acute chronic disease complications. However, the impact of the pandemic on food security will linger after social-distancing policies are lifted and the health system stabilizes, resulting in increased risk for chronic disease development, morbidity, and mortality among food-insecure households in the long-term. Research is needed to examine the impact of the pandemic-related increase in food insecurity on short- and long-term chronic health outcomes, and to delineate the underlying causal mechanisms. Such research is critical to inform the development of effective programs and policies to address food insecurity and its downstream health impacts during COVID-19 and future pandemics.
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Affiliation(s)
- Anna M Leddy
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA,Address correspondence to AML (e-mail: )
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kartika Palar
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Hilary Seligman
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Men F, Tarasuk V. Severe food insecurity associated with mortality among lower-income Canadian adults approaching eligibility for public pensions: a population cohort study. BMC Public Health 2020; 20:1484. [PMID: 32998712 PMCID: PMC7528377 DOI: 10.1186/s12889-020-09547-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/15/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The prevalence of food insecurity among adults over 65 in Canada is less than half of that among adults approaching 65, possibly due in part to the public pension universally disbursed from the age of 65. Given research associating food insecurity with higher risk of premature mortality, our objective was to determine the likelihood that food-insecure adults with incomes below the national median would live past 65 to collect the public pension. METHODS We linked respondents of the Canadian Community Health Survey 2005-15 to the death records from the Canadian Vital Statistics Database 2005-17. We assessed household food insecurity status through a validated 18-item questionnaire for 50,780 adults aged 52-64 at interview and with household income below the national median. We traced their vital status up to the age of 65. We fitted Cox proportional hazard models to compare hazard of all-cause mortality before 65 by food insecurity status while adjusting for individual demographic attributes, baseline health, and household socioeconomic characteristics. We also stratified the sample by income and analyzed the subsamples with income above and below the Low Income Measure separately. RESULTS Marginal, moderate, and severe food insecurity were experienced by 4.1, 7.3, and 4.5% of the sampled adults, respectively. The crude mortality rate was 49 per 10,000 person-years for food-secure adults and 86, 98, and 150 per 10,000 person-years for their marginally, moderately, and severely food-insecure counterparts, respectively. For the full sample and low-income subsample, respectively, severe food insecurity was associated with 1.24 (95% CI: 1.06, 1.45) and 1.28 (95% CI: 1.07, 1.52) times higher hazard of dying before 65 relative to food security. No association was found between food insecurity and mortality in the higher-income subsample. CONCLUSIONS Severely food-insecure adults approaching retirement age were more likely to die before collecting public pensions that might attenuate their food insecurity. Policymakers need to acknowledge the challenges to food security and health faced by working-age adults and provide them with adequate assistance to ensure healthy ageing into retirement.
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Affiliation(s)
- Fei Men
- Department of Nutritional Sciences, University of Toronto, Medical Sciences Building, Room 5366, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
| | - Valerie Tarasuk
- Department of Nutritional Sciences, University of Toronto, Medical Sciences Building, Room 5366, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
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Tan JY, A Sheira L, Frongillo EA, A Adimora A, Tien PC, Konkle-Parker D, Golub ET, Merenstein D, Levin S, Cohen M, Ofotokun I, A Fischl M, Rubin LH, Weiser SD. Food insecurity and neurocognitive function among women living with or at risk for HIV in the United States. Am J Clin Nutr 2020; 112:1280-1286. [PMID: 32844175 PMCID: PMC7657325 DOI: 10.1093/ajcn/nqaa209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 07/07/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Neurocognitive impairment (NCI) persists among women living with HIV. Food insecurity is also common among women and may be an important modifiable contributor of NCI. OBJECTIVE The goal of this study was to determine the association of food insecurity with neurocognitive function among women living with or without HIV. METHODS From 2013 to 2015, we analyzed data from a cross-sectional sample from the Women's Interagency HIV Study (WIHS). Measures included food insecurity and a comprehensive neuropsychological test battery assessing executive function, processing speed, attention/working memory, learning, memory, fluency, and motor function. We conducted multivariable linear regressions to examine associations between food insecurity and domain-specific neurocognitive performance, adjusting for relevant sociodemographic, behavioral, and clinical factors. RESULTS Participants (n = 1,324) were predominantly HIV seropositive (68%), Black/African-American (68%) or Hispanic (16%), and low income (48% reported <$12,000/y), with a median age of 49.6 y (IQR = 43.1, 55.5). Approximately one-third (36%, n = 479) were food insecure. Food insecurity was associated with poorer executive function (b = -1.45, SE = 0.58, P ≤ 0.01) and processing speed (b = -1.30, SE = 0.59, P ≤ 0.05). HIV serostatus modified the association between food insecurity and learning, memory, and motor function (P values <0.05). Food insecurity was positively associated with learning among women living with HIV (b = 1.58, SE = 0.77, P ≤ 0.05) and negatively associated with motor function among HIV-negative women (b = -3.57, SE = 1.08, P ≤ 0.001). CONCLUSIONS Food insecurity was associated with domain-specific neurocognitive function in women, and HIV serostatus modified associations. Food security may be an important point of intervention for ethnically diverse women with low socioeconomic status. Longitudinal studies are warranted to determine potential pathways by which food insecurity is associated with neurocognitive function among women living with or at risk for HIV.
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Affiliation(s)
- Judy Y Tan
- Address correspondence to JYT (e-mail: )
| | - Lila A Sheira
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Adaora A Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, San Francisco CA, USA,Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | | | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Susanna Levin
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Mardge Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Igho Ofotokun
- Emory University School of Medicine, Department of Medicine, Division of Infectious Disease, Atlanta, GA, USA
| | - Margaret A Fischl
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Leah H Rubin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Departments of Neurology and Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sheri D Weiser
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
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Men F, Gundersen C, Urquia ML, Tarasuk V. Association between household food insecurity and mortality in Canada: a population-based retrospective cohort study. CMAJ 2020; 192:E53-E60. [PMID: 31959655 DOI: 10.1503/cmaj.190385] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Food insecurity affects 1 in 8 households in Canada, with serious health consequences. We investigated the association between household food insecurity and all-cause and cause-specific mortality. METHODS We assessed the food insecurity status of Canadian adults using the Canadian Community Health Survey 2005-2017 and identified premature deaths among the survey respondents using the Canadian Vital Statistics Database 2005-2017. Applying Cox survival analyses to the linked data sets, we compared adults' all-cause and cause-specific mortality hazard by their household food insecurity status. RESULTS Of the 510 010 adults sampled (3 390 500 person-years), 25 460 died prematurely by 2017. Death rates of food-secure adults and their counterparts experiencing marginal, moderate and severe food insecurity were 736, 752, 834 and 1124 per 100 000 person-years, respectively. The adjusted hazard ratios (HRs) of all-cause premature mortality for marginal, moderate and severe food insecurity were 1.10 (95% confidence interval [CI] 1.03-1.18), 1.11 (95% CI 1.05-1.18) and 1.37 (95% CI 1.27-1.47), respectively. Among adults who died prematurely, those experiencing severe food insecurity died on average 9 years earlier than their food-secure counterparts (age 59.5 v. 68.9 yr). Severe food insecurity was consistently associated with higher mortality across all causes of death except cancers; the association was particularly pronounced for infectious-parasitic diseases (adjusted HR 2.24, 95% CI 1.42-3.55), unintentional injuries (adjusted HR 2.69, 95% CI 2.04-3.56) and suicides (adjusted HR 2.21, 95% CI 1.50-3.24). INTERPRETATION Canadian adults from food-insecure households were more likely to die prematurely than their food-secure counterparts. Efforts to reduce premature mortality should consider food insecurity as a relevant social determinant.
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Affiliation(s)
- Fei Men
- Department of Nutritional Sciences (Men, Tarasuk), University of Toronto, Toronto, Ont.; Department of Agricultural and Consumer Economics (Gundersen), University of Illinois, Urbana, Ill.; Department of Community Health Sciences (Urquia), University of Manitoba, Winnipeg, Man.; Li Ka Shing Knowledge Institute (Urquia), St. Michael's Hospital, Toronto, Ont.
| | - Craig Gundersen
- Department of Nutritional Sciences (Men, Tarasuk), University of Toronto, Toronto, Ont.; Department of Agricultural and Consumer Economics (Gundersen), University of Illinois, Urbana, Ill.; Department of Community Health Sciences (Urquia), University of Manitoba, Winnipeg, Man.; Li Ka Shing Knowledge Institute (Urquia), St. Michael's Hospital, Toronto, Ont
| | - Marcelo L Urquia
- Department of Nutritional Sciences (Men, Tarasuk), University of Toronto, Toronto, Ont.; Department of Agricultural and Consumer Economics (Gundersen), University of Illinois, Urbana, Ill.; Department of Community Health Sciences (Urquia), University of Manitoba, Winnipeg, Man.; Li Ka Shing Knowledge Institute (Urquia), St. Michael's Hospital, Toronto, Ont
| | - Valerie Tarasuk
- Department of Nutritional Sciences (Men, Tarasuk), University of Toronto, Toronto, Ont.; Department of Agricultural and Consumer Economics (Gundersen), University of Illinois, Urbana, Ill.; Department of Community Health Sciences (Urquia), University of Manitoba, Winnipeg, Man.; Li Ka Shing Knowledge Institute (Urquia), St. Michael's Hospital, Toronto, Ont
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Ayano G, Tsegay L, Solomon M. Food insecurity and the risk of depression in people living with HIV/AIDS: a systematic review and meta-analysis. AIDS Res Ther 2020; 17:36. [PMID: 32571426 PMCID: PMC7310141 DOI: 10.1186/s12981-020-00291-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 06/11/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The link between food insecurity and depression in people living with HIV/AIDS (PLWHA) has been explored in numerous studies; however, the existing evidence is inconclusive due to inconsistent results. Therefore, the objective of this systematic review and meta-analysis is to examine the relationship between food insecurity and depression in PLWHA. METHODS We systematically searched PubMed, EMBASE, and Scopus to identify relevant studies. A random-effect model was used for conducting the meta-analysis. We assessed the risk of publication bias by funnel plot and Egger's regression asymmetry test. RESULTS In this review, seven studies were included in the final analysis. Our meta-analysis revealed that food insecurity significantly increased the risk of depression in PLWHA [RR 2.28 (95% CI 1.56-3.32)]. This association remained significant after adjusting for the confounding effects of drug use [RR 1.63 (95% CI 1.27-2.10)], social support [RR 2.21 (95% CI 1.18-4.16)] as well as ART drugs [RR 1.96 (95% CI 1.17-3.28)]. Our subgroup and sensitivity confirmed the robustness of the main analysis. CONCLUSION This systematic review and meta-analysis suggest a significant association between food insecurity and increased risk of depression PLWHA. Therefore, early screening and management of food insecurity in PLWHA seem to be necessary.
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Affiliation(s)
- Getinet Ayano
- Research and Training Department, Amanuel Mental Specialized Hospital Addis Ababa, PO BOX 1971, Addis Ababa, Ethiopia
- School of Public Health, Curtin University, Perth, WA Australia
| | - Light Tsegay
- College of Health Sciences, Axum University, Axum, Ethiopia
| | - Melat Solomon
- Research and Training Department, Amanuel Mental Specialized Hospital Addis Ababa, PO BOX 1971, Addis Ababa, Ethiopia
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Khatri S, Amatya A, Shrestha B. Nutritional status and the associated factors among people living with HIV: an evidence from cross-sectional survey in hospital based antiretroviral therapy site in Kathmandu, Nepal. BMC Nutr 2020; 6:22. [PMID: 32549993 PMCID: PMC7294605 DOI: 10.1186/s40795-020-00346-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 03/27/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Nutritional status is the key concern among the people living with HIV but this issue has been failed to be prioritized in HIV strategic plan of Nepal. This study aims to assess the nutritional status among people living with HIV and determine their associated factors. METHODS A hospital based cross-sectional study was conducted where 350 people living with HIV attending the ART clinic were selected using systematic random sampling technique. Nutritional status among people living with HIV was assessed through anthropometry, body mass index; Underweight (body mass index < 18.5 kg/m2) and overweight/obesity (body mass index > 23 kg/m2). HIV related clinical factors such CD4 count, WHO stage, opportunistic infection, antiretroviral therapy regimen etc. were collected from the medical records. Socio-demographic data were collected using pretested structured questionnaire through interview technique. Multiple linear regression method was employed to determine the association between different independent factors and body mass index score. RESULTS The prevalence of underweight was found to be 18.3% (95% CI: 14.3-22.6). Most of the study participants were overweight/obese (39.1%). After subjection to multiple linear regression analysis, it was found that age, being male, being married, being in business occupation, smoking, hemoglobin level and antiretroviral therapy duration were significantly associated with body mass index score. Majority of the participants in our study lacked diversified food (62.3%). CONCLUSION Overweight/obesity is an emerging problem among people living with HIV. This group of participants should be screened for the presence of non-communicable disease. This study also highlights the importance of nutritional program being an integral part of HIV/AIDS continuum of care. Therefore, an effort should be made to address the burden of malnutrition by addressing the identified determinants.
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Affiliation(s)
- Samip Khatri
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Archana Amatya
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Binjwala Shrestha
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
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Summers NA, Colasanti JA, Feaster DJ, Armstrong WS, Rodriguez A, Jain MK, Jacobs P, Metsch LR, del Rio C. Predictors for Poor Linkage to Care Among Hospitalized Persons Living with HIV and Co-Occurring Substance Use Disorder. AIDS Res Hum Retroviruses 2020; 36:406-414. [PMID: 31914790 DOI: 10.1089/aid.2019.0153] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Persons living with HIV (PLWH) with substance use disorders (SUD) remain a population difficult to engage in HIV care. Project HOPE (Hospital Visits as an Opportunity for Prevention and Engagement), a randomized controlled trial testing patient navigation with/without contingency management for PLWH with SUD, aimed to address this disparity. PLWH with SUD who were out of care were recruited from 11 hospitals across the United States from 2012 to 2014. Baseline socioeconomic factors, medical mistrust scores, and perceived discrimination surveys were collected at enrollment and evaluated for effects on linkage to care at the 6-month follow-up assessment. Linkage to care (attending an outpatient visit for HIV care), early linkage to care (attending first visit within 30 days of enrollment), and engagement in care (two HIV visits within the 6-month period) were determined by medical record abstraction, supplemented by self-report. Among 801 participants enrolled in the study (mean age 45 years, 33% women, and 73% African American), those who did not complete high school and with severe food insecurity had lower odds of being linked to care at 6 months. Those with high levels of medical mistrust, recent drug use, and who did not complete high school had lower odds of early linkage to care. Early linkage was associated with higher odds of engagement at 6 months and was mitigated by both patient navigator interventions (all p < .05). Addressing social determinants of health is critical to correct the disparity seen in HIV outcomes among PLWH with SUD. Identifying factors that alter the effect of interventions could help identify patients who would benefit most.
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Affiliation(s)
- Nathan A. Summers
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan A. Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory Center for AIDS Research, Atlanta, Georgia, USA
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia, USA
| | - Daniel J. Feaster
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Wendy S. Armstrong
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory Center for AIDS Research, Atlanta, Georgia, USA
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia, USA
| | - Allan Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mamta K. Jain
- Division of Infectious Diseases, Department of Medicine, UT Southwestern, Dallas, Texas, USA
| | - Petra Jacobs
- National Institute on Drug Abuse, Bethesda, Maryland, USA
| | - Lisa R. Metsch
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia, USA
- Department of Sociomedical Sciences, Columbia Millner School of Public Health, New York City, New York, USA
| | - Carlos del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory Center for AIDS Research, Atlanta, Georgia, USA
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Crosby RA, Kubicek K, Kipke MD. Is the experience of hunger associated with risk of engaging in condomless anal sex among minority young men who have sex with men? Int J STD AIDS 2020; 31:447-453. [PMID: 32208817 PMCID: PMC8437430 DOI: 10.1177/0956462420911562] [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: 11/16/2022]
Abstract
Although emerging evidence suggests that hunger may be a risk factor for engaging in risk behaviors that lead to HIV acquisition, this has rarely been explored for young minority men who have sex with men (YMSM). This study explored a range of sexual risk behaviors for associations with a measure of hunger, assessed among 448 YMSM residing in Los Angeles, CA. Forty-five percent experienced hunger (past 12 months). Hunger was significantly associated with engaging in any condomless anal receptive sex (CARS) (adjusted odds ratio 1.74; 95% confidence interval 1.01–3.01; P .049). Further, hunger was also significantly associated with a greater percentage of CARS (Beta .12; t 2.18; P .03). Parallel effects were not observed relative to condomless anal insertive sex. Findings suggest that the experience of hunger among young minority MSM is generally not associated with a milieu of sexual risk. One important exception is that hunger may lead to having CARS. This suggests a potential ‘trade off’ for receptive partners experiencing hunger and partially supports the idea that at hunger may predispose minority YMSM to partner demands not to use condoms.
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Affiliation(s)
- Richard A Crosby
- Kinsey Institute for Research on Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Katrina Kubicek
- Community, Health Outcomes and Intervention Research Program, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Michele D Kipke
- Community, Health Outcomes and Intervention Research Program, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Bassiouni SS, White EM, Karvonen-Gutierrez C, Harlow SD. Lack of food access and food consumption patterns of late midlife women in southeast Michigan. MICHIGAN JOURNAL OF PUBLIC HEALTH 2020; 10:8. [PMID: 38274401 PMCID: PMC10809997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
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Chen C, Yang X, Zeng C, Li X, Qiao S, Zhou Y. The role of mental health on the relationship between food insecurity and immunologic outcome among people living with HIV in Guangxi, China. Health Psychol Behav Med 2020; 8:636-648. [PMID: 33777501 PMCID: PMC7993086 DOI: 10.1080/21642850.2020.1854762] [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] [Indexed: 11/24/2022] Open
Abstract
Background Previous studies showed that food insecurity could adversely affect clinical outcomes of people living with HIV (PLWH). The mental health pathways of such effects are suggested in existing literature, but empirical data are limited in resource-limited settings. Methods This cross-sectional study aims to explore the role of depressive symptoms and anxiety on the association between food insecurity and CD4 counts among a sample of 2,987 PLWH in Guangxi, China. Path analysis was used to examine a hypothetical model and delta z test was used to assess the indirect effects of food insecurity on CD4 counts through depressive symptoms and anxiety. Results The prevalence of food insecurity in this sample was 25.3%, and the median CD4 counts were 318 cells/mm3. In correlation analyses, food insecurity was not directly associated with LogCD4 but was associated with depressive symptoms and anxiety. Path analysis indicated a significant indirect effect from food insecurity to LogCD4 through depressive symptoms, but not anxiety. Conclusion Improving mental health among PLWH with food insecurity may be beneficial for treatment outcomes. Besides intervening food insecurity, an intervention targeting depressive symptoms could improve the immunologic outcomes of PLWH.
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Affiliation(s)
- Cheng Chen
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200025, China
| | - Xueying Yang
- Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, Columbia, SC, USA.,South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Chengbo Zeng
- Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, Columbia, SC, USA.,South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, Columbia, SC, USA.,South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Shan Qiao
- Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, Columbia, SC, USA.,South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, People's Republic of China
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Oumer A, Kubsa ME, Mekonnen BA. Malnutrition as predictor of survival from anti-retroviral treatment among children living with HIV/AIDS in Southwest Ethiopia: survival analysis. BMC Pediatr 2019; 19:474. [PMID: 31801487 PMCID: PMC6892183 DOI: 10.1186/s12887-019-1823-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/07/2019] [Indexed: 01/24/2023] Open
Abstract
Background Approximately 70% of HIV positive people live in Africa where food insecurity and under nutrition are endemic. However the impact of malnutrition on treatment outcome is not clear. This study assessed the effect of under nutrition on Anti-Retroviral Therapy treatment outcome among pediatric age group living with HIV/AIDS in Public Hospitals, Southwest Ethiopia. Method A retrospective cohort study was conducted on records of 242 pediatric children in Guraghe zone Public Hospitals. Also median, mean, standard deviation and interquartile range were calculated. Life table, hazard function and survival function were plotted. Log rank test with 95% confidence interval of mean survival time was done. The nutritional status data were managed via WHO Anthros plus and BMI for age Z score was calculated. To assess effects of nutritional status on mortality, both Bivariate and multivariate cox proportional hazard regression was conducted with crude (CHR) and adjusted hazard ratio (AHR) (95% confidence interval and p value). P value of less than 0.05 was used as cut off point to declare statistical significance. Results A total of 243 records of pediatric ART records with mean age of 11.6 (± 3.8 years) were reviewed. About 178 (73.3%) have got therapeutic feeding on the course of ART treatment. Whereas significant number of children, 163 (67.1%) reported to had eating problems. A total of 13 (5.3%) children were dead with incidence density of 11.2 deaths per 1000 person years. There is significantly higher survival time among well nourished (11.1 years with 95% CI: 10.8 to 11.4) as compared to underweight children (9.76 with 95% CI: 9.19 to 10.32 years). Underweight children had almost three fold increase incidence of death (AHR = 3.01; 95% CI: 0.80–11.4). Similarly children with anemia had higher incidence of death than children without anemia (AHR = 1.55; 95% CI: 0.49–4.84). Conclusions Low nutritional status at the start of ART evidenced by underweight and anemia were found to be predictors of survival among HIV positive children. There should be improved, sustained and focused nutritional screening, care and treatment for children on ART follow up.
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Affiliation(s)
- Abdu Oumer
- Department of Public Health, College of Heath Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
| | - Mina Edo Kubsa
- Department of Public Health, College of Heath Sciences and Medicine, Wolkite University, Wolkite, Ethiopia.
| | - Berhanu Abebaw Mekonnen
- Department of Nutrition and Dietetics, School of Public Heath, Bahir Dar University, Bahir Dar, Ethiopia
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Leddy AM, Roque A, Sheira LA, Frongillo EA, Landay AL, Adedimeji AA, Wilson TE, Merenstein D, Wentz E, Adimora AA, Ofotokun I, Metsch LR, Cohen MH, Tien PC, Turan JM, Turan B, Weiser SD. Food Insecurity Is Associated With Inflammation Among Women Living With HIV. J Infect Dis 2019; 219:429-436. [PMID: 30165648 DOI: 10.1093/infdis/jiy511] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/23/2018] [Indexed: 12/22/2022] Open
Abstract
Background Chronic inflammation is associated with AIDS-defining and non-AIDS-defining conditions. Limited research has considered how food insecurity influences chronic inflammation among people living with human immunodeficiency virus (HIV). We examined whether food insecurity was associated with higher levels of inflammation among women living with HIV (WWH) in the United States. Methods We analyzed cross-sectional data collected in 2015 from 421 participants on antiretroviral therapy from the Women's Interagency HIV Study. The exposure was any food insecurity. The outcome was inflammation, measured by proinflammatory cytokine interleukin-6 (IL-6) and tumor necroses factor receptor 1 (TNFR1) levels. We conducted multivariable linear regressions, adjusting for sociodemographic, clinical, and nutritional factors. Results Nearly one-third of participants (31%) were food insecure and 79% were virally suppressed (<20 copies/mL). In adjusted analyses, food insecurity was associated with 1.23 times the level of IL-6 (95% confidence interval [CI], 1.06-1.44) and 1.13 times the level of TNFR1 (95% CI, 1.05-1.21). Findings did not differ by HIV control (virally suppressed with CD4 counts ≥500 cells/mm3 or not) in adjusted stratified analyses. Conclusion Food insecurity was associated with elevated inflammation among WWH regardless of HIV control. Findings support the need for programs that address food insecurity among WWH.
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Affiliation(s)
- Anna M Leddy
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California San Francisco.,Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco
| | - Annelys Roque
- Department of Medicine, University of California San Francisco
| | - Lila A Sheira
- Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia
| | - Alan L Landay
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, Illinois
| | - Adebola A Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Tracey E Wilson
- Department of Community Health Sciences, School of Public Health, SUNY Downstate, Brooklyn, New York
| | - Daniel Merenstein
- Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia
| | - Eryka Wentz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Adaora A Adimora
- School of Medicine, University of North Carolina at Chapel Hill, North Carolina
| | - Igho Ofotokun
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York
| | - Mardge H Cohen
- Division of General Internal Medicine, Cook County Health and Hospital System, Chicago, Illinois
| | - Phyllis C Tien
- Department of Medicine, University of California San Francisco
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health
| | - Bulent Turan
- Department of Psychology, University of Alabama at Birmingham
| | - Sheri D Weiser
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California San Francisco.,Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco
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Glynn TR, Safren SA, Carrico AW, Mendez NA, Duthely LM, Dale SK, Jones DL, Feaster DJ, Rodriguez AE. High Levels of Syndemics and Their Association with Adherence, Viral Non-suppression, and Biobehavioral Transmission Risk in Miami, a U.S. City with an HIV/AIDS Epidemic. AIDS Behav 2019; 23:2956-2965. [PMID: 31392443 DOI: 10.1007/s10461-019-02619-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Miami is a Southeastern United States (U.S.) city with high health, mental health, and economic disparities, high ethnic/racial diversity, low resources, and the highest HIV incidence and prevalence in the country. Syndemic theory proposes that multiple, psychosocial comorbidities synergistically fuel the HIV/AIDS epidemic. People living with HIV/AIDS in Miami may be particularly affected by this due to the unique socioeconomic context. From April 2017 to October 2018, 800 persons living with HIV/AIDS in a public HIV clinic in Miami completed an interviewer-administered behavioral and chart-review cross-sectional assessment to examine the prevalence and association of number of syndemics (unstable housing, low education, depression, anxiety, binge drinking, drug use, violence, HIV-related stigma) with poor ART adherence, unsuppressed HIV viral load (≥ 200 copies/mL), and biobehavioral transmission risk (condomless sex in the context of unsuppressed viral load). Overall, the sample had high prevalence of syndemics (M = 3.8), with almost everyone (99%) endorsing at least one. Each syndemic endorsed was associated with greater odds of: less than 80% ART adherence (aOR 1.64, 95% CI 1.38, 1.98); having unsuppressed viral load (aOR 1.16, 95% CI 1.01, 1.33); and engaging in condomless sex in the context of unsuppressed viral load (1.78, 95% CI 1.30, 2.46). The complex syndemic of HIV threatens to undermine the benefits of HIV care and are important to consider in comprehensive efforts to address the disproportionate burden of HIV/AIDS in the Southern U.S. Achieving the 90-90-90 UNAIDS and the recent U.S. "ending the epidemic" targets will require efforts addressing the structural, social, and other syndemic determinants of HIV treatment and prevention.
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Affiliation(s)
- Tiffany R Glynn
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Noelle A Mendez
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Lunthita M Duthely
- Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Allan E Rodriguez
- Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
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Assessing the impact of food insecurity on HIV medication adherence in the context of an integrated care programme for people living with HIV in Vancouver, Canada. Public Health Nutr 2019; 23:683-690. [PMID: 31507259 DOI: 10.1017/s1368980019002532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Food insecurity, or self-reports of inadequate food access due to limited financial resources, remains prevalent among people living with HIV (PLHIV). We examined the impact of food insecurity on combination antiretroviral therapy (cART) adherence within an integrated care programme that provides services to PLHIV, including two meals per day. DESIGN Adjusted OR (aOR) were estimated by generalized estimating equations, quantifying the relationship between food insecurity (exposure) and cART adherence (outcome) with multivariable logistic regression. SETTING We drew on survey data collected between February 2014 and March 2016 from the Dr. Peter Centre Study based in Vancouver, Canada. PARTICIPANTS The study included 116 PLHIV at baseline, with ninety-nine participants completing a 12-month follow-up interview. The median (quartile 1-quartile 3) age was 46 (39-52) years at baseline and 87 % (n 101) were biologically male at birth. RESULTS At baseline, 74 % (n 86) of participants were food insecure (≥2 affirmative responses on Health Canada's Household Food Security Survey Module) and 67 % (n 78) were adherent to cART ≥95 % of the time. In the adjusted regression analysis, food insecurity was associated with suboptimal cART adherence (aOR = 0·47, 95 % CI 0·24, 0·93). CONCLUSIONS While food provision may reduce some health-related harms, there remains a relationship between this prevalent experience and suboptimal cART adherence in this integrated care programme. Future studies that elucidate strategies to mitigate food insecurity and its effects on cART adherence among PLHIV in this setting and in other similar environments are necessary.
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Bello TK, Gericke GJ, Maclntyre UE, Becker P. A nutrition education programme improves quality of life but not anthropometric status of adults living with HIV in Abeokuta, Nigeria. Public Health Nutr 2019; 22:2290-2302. [PMID: 31084656 PMCID: PMC10260542 DOI: 10.1017/s1368980019000636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 01/30/2019] [Accepted: 02/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The focus of interventions for adults living with HIV (ALH) in Nigeria has been mostly on prevention and provision of antiretroviral therapy (ART) with little consideration to nutrition-related matters. Therefore, the present study aimed to improve the quality of life (QoL) and anthropometric status of ALH in Abeokuta, Nigeria. DESIGN A quasi-experimental design where 200 conveniently selected participants were stratified by gender and duration on ART. The intervention group (n 100) received the nutrition education programme (NEP) for 12 weeks. The control group received a brochure on nutrition guidelines for ALH. Socio-biographical information, QoL and anthropometric status were assessed using previously validated questionnaires and standard techniques at baseline, week 12 and week 24. Generalised least squares (GLS) regression analysis was used for group comparisons. Anthropometric status was summarised by gender. SETTING Two tertiary hospitals in Abeokuta, Nigeria. PARTICIPANTS ALH. RESULTS The NEP led to significant improvement in the physical functioning (week 12 and 24: P < 0·01), role limitation due to physical health (week 12: P = 0·01; week 24: P = 0·002) and pain (week 12: P = 0·01) constructs of the QoL of the intervention group compared with the control group. There was no significant difference (P = 0·07) between the mean weights of the two groups at baseline. CONCLUSIONS There was a significant improvement at week 12 and week 24 in the QoL of the intervention participants. The results indicated that a tailored NEP could make a positive contribution to the management of ALH.
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Affiliation(s)
- Temitope K Bello
- Department of Human Nutrition, University of Pretoria, Private Bag X323, Pretoria 0001, South Africa
| | - Gerda J Gericke
- Department of Human Nutrition, University of Pretoria, Private Bag X323, Pretoria 0001, South Africa
| | - Una E Maclntyre
- Department of Human Nutrition, University of Pretoria, Private Bag X323, Pretoria 0001, South Africa
| | - Piet Becker
- Research Office, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Barreto D, Shoveller J, Braschel M, Duff P, Shannon K. The Effect of Violence and Intersecting Structural Inequities on High Rates of Food Insecurity among Marginalized Sex Workers in a Canadian Setting. J Urban Health 2019; 96:605-615. [PMID: 30039301 PMCID: PMC6890872 DOI: 10.1007/s11524-018-0281-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Food security is both a basic human right and a public health necessity. Despite known gendered contexts of food insecurity, there is a dearth of research on prevalence and factors driving increased food insecurity for sex workers in a criminalized setting. The current study longitudinally examines the prevalence and structural and individual factors associated with increased odds of food insecurity among street and off-street sex workers in a Canadian urban setting. Prospective analyses drew on data from a community-based longitudinal cohort of cis and trans women in street and off-street sex work in An Evaluation of Sex Workers Health Access (2010-2014). The primary outcome was a time-updated measure of food insecurity, using the Radimer-Cornell scale. We used bivariable and multivariable logistic regression using generalized estimating equations to prospectively model correlates of food insecurity over a five-year period. Of 761 cis and trans women sex workers, 72.4% (n = 551) were food insecure over the study period. Over a third (35.2%, n = 268) identified as Indigenous and a quarter, 25.6% (n = 195) were of a gender/sexual minority. Within the 11.0% (n = 84) of women living with HIV, 96.4% (n = 81) were food insecure over the follow-up period. In multivariable analysis, Indigenous ancestry (AOR = 1.58 [95% CI 1.18, 2.10]), unstable housing (AOR = 1.27 [95% CI 1.03, 1.57]), stimulant use (AOR = 1.97 [95% CI 1.57, 2.45]), heroin use (AOR = 1.72 [95% CI 1.36, 2.19]), mental health diagnosis (AOR = 2.38 [95% CI 1.85, 3.05]), recent violence (AOR = 1.54 [95% CI 1.24, 1.91]), means of food access: reliant on food services only vs. self-sufficient (AOR = 1.78 [95% CI 1.38, 2.29]), and means of food access: both vs. self-sufficient (AOR = 2.29 [95% CI 1.84, 2.86]) were associated with food insecurity. In separate multivariable models, both recent and lifetime physical and/or sexual violence remained independently associated with food insecurity (AOR 1.54 [95% CI 1.24, 1.91]; AOR 4.62 [95% CI 2.99, 7.14], respectively). Almost all study participants living with HIV reported being food insecure. These intersecting risks demonstrate the negative impacts associated with living with HIV, experiencing food insecurity and/or physical or sexual violence. This study also highlights the potential for interventions that address structural inequities (e.g., decriminalizing sex work) to have crosscutting impacts to reduce barriers to accessing necessities (including food) or health and social services (e.g., methadone; primary care).
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Affiliation(s)
- Daniella Barreto
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Jeannie Shoveller
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Melissa Braschel
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Putu Duff
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kate Shannon
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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