TY - JOUR
T1 - The social context of food insecurity among persons living with HIV/AIDS in rural Uganda
AU - Tsai, Alexander C.
AU - Bangsberg, David R.
AU - Emenyonu, Nneka
AU - Senkungu, Jude K.
AU - Martin, Jeffrey N.
AU - Weiser, Sheri D.
N1 - Funding Information:
We thank the Uganda AIDS Rural Treatment Outcomes study participants who made this study possible by sharing their experiences; Annet Kawuma and Annet Kembabazi for providing study coordination and support; and Doreen Akello, Marcy Mutumba, Christine Ngabirano, Ruth Ssentongo, and Florence Turyashemererwa for research assistance. Edward Frongillo, Jessica Haberer, Peter W. Hunt, and F.B. Nozmo Mukiibi provided invaluable input on study design and implementation. While these individuals are acknowledged for their assistance, no endorsement of manuscript contents or conclusions should be inferred. The study was funded by U.S. National Institutes of Health K23 MH-79713 and MH-79713-03S1 (PI: Weiser), R01 MH-054907 (PI: Bangsberg), P30 AI27763 ( UCSF-Gladstone Institute Center for AIDS Research ), and the Tim and Jane Meyer Family Foundation . The authors acknowledge the following additional sources of support: Robert Wood Johnson Foundation Health & Society Scholars Program (Tsai), K24 MH-087227 (Bangsberg), and the Burke Family Foundation (Weiser).
PY - 2011/12
Y1 - 2011/12
N2 - HIV/AIDS and food insecurity are two of the leading causes of morbidity and mortality in sub-Saharan Africa, with each heightening the vulnerability to, and worsening the severity of, the other. Less research has focused on the social determinants of food insecurity in resource-limited settings, including social support and HIV-related stigma. In this study, we analyzed data from a cohort of 456 persons from the Uganda AIDS Rural Treatment Outcomes study, an ongoing prospective cohort of persons living with HIV/AIDS (PLWHA) initiating HIV antiretroviral therapy in Mbarara, Uganda. Quarterly data were collected by structured interviews. The primary outcome, food insecurity, was measured with the Household Food Insecurity Access Scale. Key covariates of interest included social support, internalized HIV-related stigma, HIV-related enacted stigma, and disclosure of HIV serostatus. Severe food insecurity was highly prevalent overall (38%) and more prevalent among women than among men. Social support, HIV disclosure, and internalized HIV-related stigma were associated with food insecurity; these associations persisted after adjusting for household wealth, employment status, and other previously identified correlates of food insecurity. The adverse effects of internalized stigma persisted in a lagged specification, and the beneficial effect of social support further persisted after the inclusion of fixed effects. International organizations have increasingly advocated for addressing food insecurity as part of HIV/AIDS programming to improve morbidity and mortality. This study provides quantitative evidence on social determinants of food insecurity among PLWHA in resource-limited settings and suggests points of intervention. These findings also indicate that structural interventions to improve social support and/or decrease HIV-related stigma may also improve the food security of PLWHA.
AB - HIV/AIDS and food insecurity are two of the leading causes of morbidity and mortality in sub-Saharan Africa, with each heightening the vulnerability to, and worsening the severity of, the other. Less research has focused on the social determinants of food insecurity in resource-limited settings, including social support and HIV-related stigma. In this study, we analyzed data from a cohort of 456 persons from the Uganda AIDS Rural Treatment Outcomes study, an ongoing prospective cohort of persons living with HIV/AIDS (PLWHA) initiating HIV antiretroviral therapy in Mbarara, Uganda. Quarterly data were collected by structured interviews. The primary outcome, food insecurity, was measured with the Household Food Insecurity Access Scale. Key covariates of interest included social support, internalized HIV-related stigma, HIV-related enacted stigma, and disclosure of HIV serostatus. Severe food insecurity was highly prevalent overall (38%) and more prevalent among women than among men. Social support, HIV disclosure, and internalized HIV-related stigma were associated with food insecurity; these associations persisted after adjusting for household wealth, employment status, and other previously identified correlates of food insecurity. The adverse effects of internalized stigma persisted in a lagged specification, and the beneficial effect of social support further persisted after the inclusion of fixed effects. International organizations have increasingly advocated for addressing food insecurity as part of HIV/AIDS programming to improve morbidity and mortality. This study provides quantitative evidence on social determinants of food insecurity among PLWHA in resource-limited settings and suggests points of intervention. These findings also indicate that structural interventions to improve social support and/or decrease HIV-related stigma may also improve the food security of PLWHA.
KW - Food security
KW - HIV/AIDS
KW - International health
KW - Social support
KW - Stigma
KW - Uganda
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U2 - 10.1016/j.socscimed.2011.09.026
DO - 10.1016/j.socscimed.2011.09.026
M3 - Article
C2 - 22019367
AN - SCOPUS:81555202514
SN - 0277-9536
VL - 73
SP - 1717
EP - 1724
JO - Social Science and Medicine
JF - Social Science and Medicine
IS - 12
ER -