Food Insecurity Is Associated with HIV, Sexually Transmitted Infections & Drug Use among Men in the U.S.

OBJECTIVE:

To examine the population-level association between food insecurity, HIV risk factors, and HIV serostatus among men, the group representing the majority of HIV diagnoses in the United States (US).

DESIGN:

Cross-sectional secondary data analysis using the National Health and Nutrition Examination Survey (NHANES) 1999-2012, a nationally representative survey of the civilian non-institutionalized US population.

METHODS:

Logistic regression with design weights and complex survey commands was used to estimate nationally-representative associations between food insecurity and HIV serostatus (primary outcome), herpes simplex virus 2 (HSV-2), self-reported STIs, and past-year illicit drug use among men, adjusting for potential confounders. Food security was measured using the 18-item Household Food Security Survey.

RESULTS:

We analyzed data for 9150 men representing 61 million individuals in the US. Unadjusted HIV prevalence was 1.5% among food insecure men, compared to 0.4% among food secure men (p < 0.001). In adjusted models, food insecure men had over 2 times higher odds of HIV seropositivity compared to food secure men (adjusted odds ratio (AOR) = 2.10; 95% CI 1.01-4.37; p < 0.05). Food insecurity was associated with higher odds of HSV-2 seropositivity (AOR = 1.28; 95% CI 1.04-1.57; p < 0.05), self-reported STIs (AOR = 1.54; 95% CI 1.08-2.20; p < 0.05), and illicit drug use (AOR = 1.57; 95% CI 1.14-2.15; p < 0.01). Results were robust to sensitivity analyses restricted to lower incomes.

CONCLUSIONS:

Food insecurity is associated with prevalent HIV, STIs and illicit drug use among men in the US. Further research is needed to establish whether and through what mechanisms improved food security may help prevent new HIV infections.

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By:  Palar K1, Laraia B, Tsai AC, Johnson M, Weiser SD.

• 1 Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA 
• School of Public Health, University of California Berkeley, Berkeley, CA 
• Massachusetts General Hospital, MGH Global Health, Boston, MA 
• Center for AIDS Prevention Studies, Department of Medicine, UCSF.
• AIDS. 2016 Mar 16. 

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