Journal of Community Health

, Volume 39, Issue 6, pp 1133–1139 | Cite as

Food Insecurity and Other Poverty Indicators Among People Living with HIV/AIDS: Effects on Treatment and Health Outcomes

  • Seth C. Kalichman
  • Dominica Hernandez
  • Chauncey Cherry
  • Moira O. Kalichman
  • Christopher Washington
  • Tamar Grebler
Original Paper


Health disparities in access to antiretroviral therapy (ART) as well as the demands of long-term medication adherence have meant the full benefits of HIV treatment are often not realized. In particular, food insecurity has emerged as a robust predictor of ART non-adherence. However, research is limited in determining whether food insecurity uniquely impedes HIV treatment or if food insecurity is merely a marker for poverty that interferes more broadly with treatment. This study examined indicators of poverty at multiple levels in a sample of 364 men and 157 women living with HIV recruited through an offering of a free holiday food basket. Results showed that 61 % (N = 321) of participants had experienced at least one indicator of food insecurity in the previous month. Multivariate analyses showed that food insecurity was closely tied to lack of transportation. In addition, food insecurity was associated with lacking access to ART and poor ART adherence after adjusting for neighbourhood poverty, living in an area without a supermarket (food desert), education, stable housing, and reliable transportation. Results therefore affirm previous research that has suggested food insecurity is uniquely associated with poor ART adherence and calls for structural interventions that address basic survival needs among people living with HIV, especially food security.


Food insecurity Poverty and health HIV infection 



This project was supported by National Institute of Alcohol Abuse and Alcoholism Grant R01-AA021471.


  1. 1.
    Bangsberg, D., Kroetz, D. L., & Deeks, S. (2007). Adherence-resistance relationships to combination HIV antiretroviral therapy. Current HIV/AIDS Reports, 4, 65–72.PubMedCrossRefGoogle Scholar
  2. 2.
    Zhang, S., Senteio, C., Felizzola, J., & Rust, G. (2013). Racial/ethnic disparities in antiretroviral treatment among HIV-infected pregnant Medicaid enrollees, 2005–2007. American Journal of Public Health, 103(12), e46–e53.PubMedCrossRefGoogle Scholar
  3. 3.
    Reif, S. S., Whetten, K., Wilson, E. R., McAllaster, C., Pence, B. W., Legrand, S., et al. (2013). HIV/AIDS in the Southern USA: A disproportionate epidemic. AIDS Care, 26, 351–359.Google Scholar
  4. 4.
    Jarrett, O. D., Wanke, C. A., Ruthazer, R., Bica, I., Isaac, R., & Knox, T. A. (2013). Metabolic syndrome predicts all-cause mortality in persons with human immunodeficiency virus. AIDS Patient Care STDs, 27(5), 266–271.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Franke, M. F., Murray, M. B., Munoz, M., Hernandez-Diaz, S., Sebastian, J. L., Atwood, S., et al. (2011). Food insufficiency is a risk factor for suboptimal antiretroviral therapy adherence among HIV-infected adults in urban Peru. AIDS and Behavior, 15, 1483–1489.Google Scholar
  6. 6.
    Vogenthaler, N. S., Hadley, C., Lewis, S. J., Rodriguez, A. E., Metsch, L. R., & del Rio, C. (2010). Food insufficiency among HIV-infected crack-cocaine users in Atlanta and Miami. Public Health Nutrition, 13(9), 1478–1484.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Normen, L., Chan, E. S., Braitstein, P., Annema, A., Bondy, G., & Montaner, J. (2005). Food insecurity and hunger are prevalent among HIV-positive individuals in British Columbia, Canada. Journal of Nutrition, 135, 820–825.PubMedGoogle Scholar
  8. 8.
    Kalichman, S. C., Pellowski, J., Kalichman, M. O., Cherry, C., Detorio, M., Caliendo, A. M., et al. (2011). Food insufficiency and medication adherence among people living with HIV/AIDS in urban and peri-urban settings. Prevention Science: The Official Journal of the Society for Prevention Research, 12(3), 324–332.CrossRefGoogle Scholar
  9. 9.
    Kalichman, S. C., Watt, M., Sikkema, K., Skinner, D., & Pieterse, D. (2012). Food insufficiency, substance use, and sexual risks for HIV/AIDS in informal drinking establishments, Cape Town, South Africa. Journal of Urban Health, 89, 939–951.Google Scholar
  10. 10.
    Kalichman, S. C., Cherry, C., Amaral, C., White, D., Kalichman, M. O., Pope, H., et al. (2010). Health and treatment implications of food insufficiency among people living with HIV/AIDS, Atlanta, Georgia. Journal of Urban Health, 87(4), 631–641.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Ivers, L. C., Cullen, K. A., Freedberg, K. A., Block, S., Coates, J., & Webb, P. (2009). HIV/AIDS, undernutrition, and food insecurity. Clinical Infectious Diseases, 49(7), 1096–1102.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Weiser, S. D., Bangsberg, D. R., Kegeles, S., Ragland, K., Kushel, M. B., & Frongillo, E. A. (2009). Food insecurity among homeless and marginally housed individuals living with HIV/AIDS in San Francisco. AIDS and Behavior, 13, 841–848.Google Scholar
  13. 13.
    Weiser, S. D., Frongillo, E. A., Ragland, K., Hogg, R. S., Riley, E. D., & Bangsberg, D. R. (2009). Food insecurity is associated with incomplete HIV RNA suppression among homeless and marginally housed HIV-infected individuals in San Francisco. Journal of General Internal Medicine, 24(1), 14–20.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Weiser, S. D., Fernandes, K. A., Brandson, E. K., Lima, V. D., Anema, A., Bangsberg, D. R., et al. (2009). The association between food insecurity and mortality among HIV-infected individuals on HAART. Journal of Acquired Immune Deficiency Syndromes, 52, 342–349.Google Scholar
  15. 15.
    Crum-Cianflone, N., Tejidor, R., Medina, S., Barahona, I., & Ganesan, A. (2008). Obesity among patients with HIV: The latest epidemic. AIDS Patient Care STDs, 22(12), 925–930.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Crum-Cianflone, N. F., Roediger, M., Eberly, L. E., Vyas, K., Landrum, M. L., Ganesan, A., et al. (2010). Obesity among HIV-infected persons: Impact of weight on CD4 cell count. AIDS, 24(7), 1069–1072.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    van der Sande, M. A., Schim van der Loeff, M. F., Aveika, A. A., Sabally, S., Togun, T., Sarge-Njie, R., et al. (2004). Body mass index at time of HIV diagnosis: A strong and independent predictor of survival. Journal of Acquired Immune Deficiency Syndromes, 37(2), 1288–1294.PubMedCrossRefGoogle Scholar
  18. 18.
    Paula, A. A., Falcao, M. C., & Pacheco, A. G. (2013). Metabolic syndrome in HIV-infected individuals: Underlying mechanisms and epidemiological aspects. AIDS Research and Therapy, 10(1), 32.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Weiser, S. D., Hatcher, A., Frongillo, E. A., Guzman, D., Riley, E. D., Bangsberg, D. R., et al. (2012). Food insecurity is associated with greater acute care utilization among HIV-infected homeless and marginally housed individuals in San Francisco. Journal of General Internal Medicine, 28, 91–98.Google Scholar
  20. 20.
    Pellowski, J. A., Kalichman, S. C., Matthews, K. A., & Adler, N. (2013). A pandemic of the poor: Social disadvantage and the U.S. HIV epidemic. American Psychologist, 68(4), 197–209.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Leaver, C. A., Bargh, G., Dunn, J. R., & Hwang, S. W. (2007). The effects of housing status on health-related outcomes in people living with HIV: A systematic review of the literature. AIDS and Behavior, 11(6 Suppl), 85–100.PubMedCrossRefGoogle Scholar
  22. 22.
    Boehme, A. K., Davies, S. L., Moneyham, L., Shrestha, S., Schumacher, J., & Kempf, M. C. (2013). A qualitative study on factors impacting HIV care adherence among postpartum HIV-infected women in the rural southeastern USA. AIDS Care, 26, 574–581.Google Scholar
  23. 23.
    Tuller, D. M., Bangsberg, D. R., Senkungu, J., Ware, N. C., Emenyonu, N., & Weiser, S. D. (2010). Transportation costs impede sustained adherence and access to HAART in a clinic population in southwestern Uganda: A qualitative study. AIDS and Behavior, 14, 778–784.Google Scholar
  24. 24.
    Aiello, A. E., Simanek, A. M., & Galea, S. (2010). Population levels of psychological stress, herpesvirus reactivation and HIV. AIDS and Behavior, 14(2), 308–317.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Latkin, C. A., Curry, A. D., Hua, W., & Davey, M. A. (2007). Direct and indirect associations of neighborhood disorder with drug use and high-risk sexual partners. American Journal of Preventive Medicine, 32(6 Suppl), S234–S241.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Alvaro, C., Lyons, R. F., Warner, G., Hobfoll, S. E., Martens, P. J., Labonte, R., et al. (2010). Conservation of resources theory and research use in health systems. Implementation Science, 5, 79.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Hobfoll, S. E. (2012). Conservation of resources and disaster in cultural context: The caravans and passageways for resources. Psychiatry, 75(3), 227–232.PubMedGoogle Scholar
  28. 28.
    Kalichman, S. C., Rompa, D., & Cage, M. (2000). Reliability and validity of self-reported CD4 lymphocyte count and viral load test results in people living with HIV/AIDS. International Journal of STD & AIDS, 11(9), 579–585.CrossRefGoogle Scholar
  29. 29.
    Simoni, J., Kurth, A. E., Pearson, C., Pantalone, D. W., Merrill, J., & Frick, P. (2006). Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management. AIDS Behavior, 10, 227–331.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Bangsberg, D., Hecht, F. M., Charlebois, E. D., Chesney, M., & Moss, A. (2001). Comparing objective measures of adherence to HIV antiretroviral therapy: Electronic medication monitors and unannounced pill counts. AIDS and Behavior, 5, 275–281.CrossRefGoogle Scholar
  31. 31.
    Giordano, T. P., Guzman, D., Clark, R., Charlebois, E. D., & Bangsberg, D. (2004). Measuring adherence to antiretroviral therapy in a diverse population using a visual analogue scale. HIV Clinical Trials, 5, 74–79.PubMedCrossRefGoogle Scholar
  32. 32.
    Hiltner, S. (1973). The Tuskegee Syphilis Study under review. Christ Century, 90(43), 1174–1176.PubMedGoogle Scholar
  33. 33.
    Bangsberg, D. (2006). Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression. Clinical Infectious Diseases, 43, 939–941.PubMedCrossRefGoogle Scholar
  34. 34.
    Coates, J., Swindale, A., & Bilinsky, P. (2007). Household Food Insecurity Access Scale (HFIAS) for measurement of food access: Indicator guide. USAID. Washington, DC: Academy for Educational Development.Google Scholar
  35. 35.
    Parienti, J. J., Das-Douglas, M., Massari, V., Guzman, D., Deeks, S. G., Verdon, R., et al. (2008). Not all missed doses are the same: Sustained NNRTI treatment interruptions predict HIV rebound at low-to-moderate adherence levels. PLoS One, 3(7), e2783.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Cantrell, R. A., Sinkala, M., Megazinni, K., Lawson-Marriott, S., Washington, S., Chi, B. H., et al. (2008). A pilot study of food supplementation to improve adherence to antiretroviral therapy among food-insecure adults in Lusaka, Zambia. J Acquir Immune Defic Syndr., 49(2), 190–195.PubMedCrossRefGoogle Scholar
  37. 37.
    Ivers, L., Chang, Y., Jerome, G., & Freedberg, K. (2010). Food assistance is associated with improved body mass index, food security, and attendance to clinic in an HIV program in central Haiti: A prospective observational study. AIDS Research and Therapy, 7, 33.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Seth C. Kalichman
    • 1
  • Dominica Hernandez
    • 1
  • Chauncey Cherry
    • 1
  • Moira O. Kalichman
    • 1
  • Christopher Washington
    • 1
  • Tamar Grebler
    • 1
  1. 1.Department of PsychologyUniversity of ConnecticutStorrsUSA

Personalised recommendations