Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS1234

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Food insecurity, which affects >1 billion people worldwide, is inextricably linked to the HIV epidemic. We present a conceptual framework of the multiple pathways through which food insecurity and HIV/AIDS may be linked at the community, household, and individual levels. Whereas the mechanisms through which HIV/AIDS can cause food insecurity have been fairly well elucidated, the ways in which food insecurity can lead to HIV are less well understood. We argue that there are nutritional, mental health, and behavioral pathways through which food insecurity leads to HIV acquisition and disease progression. Specifically, food insecurity can lead to macronutrient and micronutrient deficiencies, which can affect both vertical and horizontal transmission of HIV, and can also contribute to immunologic decline and increased morbidity and mortality among those already infected. Food insecurity can have mental health consequences, such as depression and increased drug abuse, which, in turn, contribute to HIV transmission risk and incomplete HIV viral load suppression, increased probability of AIDS-defining illness, and AIDS-related mortality among HIV-infected individuals. As a result of the inability to procure food in socially or personally acceptable ways, food insecurity also contributes to risky sexual practices and enhanced HIV transmission, as well as to antiretroviral therapy nonadherence, treatment interruptions, and missed clinic visits, which are strong determinants of worse HIV health outcomes. More research on the relative importance of each of these pathways is warranted because effective interventions to reduce food insecurity and HIV depend on a rigorous understanding of these multifaceted relationships.

Abbreviations:

ART
antiretroviral therapy
HAART
highly active antiretroviral therapy
PLWHA
people living with HIV or AIDS

Cited by (0)

1

From the Division of HIV/AIDS and the Center for AIDS/Prevention Studies (SDW and AMH), and the Division of General Internal Medicine (MBK), San Francisco General Hospital; the Department of Obstetrics, Gynecology and Reproductive Sciences (SLY, CRC, and AMH), and the Department of Medicine (PCT), University of California, San Francisco, San Francisco, CA; Robert Wood Johnson Health and Society Scholars Program, Harvard University, Cambridge, MA (ACT); San Francisco Veterans Affairs Medical Center, San Francisco, CA (PCT); the Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina; Columbia, SC (EAF); Division of Nutritional Sciences, Cornell University (SLY); and Massachusetts General Hospital Center for Global Health, Ragon Institute of MGH, MIT and Harvard, Harvard Medical School, and Mbarara University of Science and Technology, Mbarara, Uganda (DRB).

2

Presented at the conference “Nutrition in Clinical Management of HIV-Infected Adolescents (>14 y old) and Adults including Pregnant and Lactating Women: What Do We Know, What Can We Do, and Where Do We Go from Here?” held in Washington, DC, 26–28 July 2010.

3

Supported by National Institute of Mental Health (NIMH) 79713-01; the University of California, San Francisco, AIDS Research Institute; The Burke Global Health Faculty Award; and the California HIV/AIDS Research Program ID08-SF-054 (SDW); by Robert Wood Johnson Health and Society Scholars Program (ACT); and by NIMH 54907 and NIMH 87227 (DRB).

4

Address correspondence to S Weiser, Positive Health Program, PO Box 0874, UCSF, San Francisco, CA 94143. E-mail: [email protected]