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Psychosocial Factors Associated with Food Insufficiency Among People Living with HIV/AIDS (PLWH) Initiating ART in Ethiopia

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Madeline Dilorenzo at Boston Medical Center
Madeline Dilorenzo
Angela Parcesepe
Angela Parcesepe
Angela Parcesepe
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Olga Tymejczyk
Olga Tymejczyk
Olga Tymejczyk
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Susie Hoffman
Susie Hoffman
Susie Hoffman
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Abstract

Food insufficiency is associated with suboptimal HIV treatment outcomes. Less is known about psychosocial correlates of food insufficiency among PLWH. This sample includes 1176 adults initiating antiretroviral therapy at HIV clinics in Ethiopia. Logistic regression modeled the association of psychological distress, social support, and HIV-related stigma with food insufficiency. Among respondents, 21.4% reported frequent food insufficiency. Psychological distress [adjusted odds ratio (aOR) 2.61 (95% CI 1.79, 3.82)], low social support [aOR 2.20 (95% CI 1.57, 3.09)] and enacted stigma [aOR 1.69 (95% CI 1.26, 2.25)] were independently associated with food insufficiency. Food insufficiency interventions should address its accompanying psychosocial context.
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Vol:.(1234567890)
AIDS and Behavior (2019) 23:3052–3057
https://doi.org/10.1007/s10461-019-02505-9
1 3
ORIGINAL PAPER
Psychosocial Factors Associated withFood Insuciency Among People
Living withHIV/AIDS (PLWH) Initiating ART inEthiopia
MadelineA.DiLorenzo1 · AngelaParcesepe2· OlgaTymejczyk1,3· SusieHoman4,5· BatyaElul5· SheriD.Weiser6·
RobertH.Remien4· SarahGorrellKulkarni1· TsigeredaGadisa7· ZenebeMelaku7· DenisNash1,3
Published online: 15 April 2019
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract
Food insufficiency is associated with suboptimal HIV treatment outcomes. Less is known about psychosocial correlates of
food insufficiency among PLWH. This sample includes 1176 adults initiating antiretroviral therapy at HIV clinics in Ethio-
pia. Logistic regression modeled the association of psychological distress, social support, and HIV-related stigma with food
insufficiency. Among respondents, 21.4% reported frequent food insufficiency. Psychological distress [adjusted odds ratio
(aOR) 2.61 (95% CI 1.79, 3.82)], low social support [aOR 2.20 (95% CI 1.57, 3.09)] and enacted stigma [aOR 1.69 (95%
CI 1.26, 2.25)] were independently associated with food insufficiency. Food insufficiency interventions should address its
accompanying psychosocial context.
Keywords Food insufficiency· HIV· ART · Psychological distress· Social support· Stigma
Introduction
Food insecurity, “the limited or uncertain availability of
nutritionally adequate, safe foods, or the inability to procure
food in socially acceptable ways,” is a significant problem
in Sub-Saharan Africa [1]. In Ethiopia specifically, it has
been estimated that 35% of the population is food insecure
[2]. Food insecurity is more prevalent among people living
with HIV/AIDS (PLWH) than the general population and
has been associated with worse HIV outcomes, including
lower CD4 counts, sub-optimal adherence to antiretroviral
therapy (ART), and increased HIV viral load [3, 4].
Food insecurity is associated with poor mental health
among PLWH, particularly among those with low levels of
social support [5]. Qualitative research with PLWH suggests
that HIV-related stigma may contribute to the risk of food
insecurity through employment discrimination and social
distancing of family, friends, and community members [6].
Food insufficiency, one component of food insecurity, is
defined as having an inadequate amount of food and has
been associated with moderate or severe food insecurity.
Previous estimates of food insufficiency among PLWH in
sub-Saharan Africa have varied. A study of pregnant women
living with HIV in Uganda found that 7% reported severe
food insufficiency and 41% reported moderate food insuf-
ficiency within the past 4weeks [3].
Food insufficiency has been associated with a number of
psychosocial factors, including lowsocial support, stigma,
and mental health among general populations. Less is
known about psychosocial correlates of food insufficiency
among PLWH, particularly in sub-Saharan Africa. A greater
* Madeline A. DiLorenzo
madeline.dilorenzo@bmc.org
1 Institute forImplementation Science inPopulation Health,
City University ofNew York, 55 West 125th Street,
NewYork, NY10027, USA
2 Department ofMaternal andChild Health, Gillings School
ofGlobal Public Health, University ofNorth Carolina
atChapel Hill, ChapelHill, NC, USA
3 Graduate School ofPublic Health andHealth Policy, City
University ofNew York, NewYork, NY, USA
4 HIV Center forClinical andBehavioral Studies, Columbia
University andNew York State Psychiatric Institute,
NewYork, NY, USA
5 Department ofEpidemiology, Columbia University,
NewYork, NY, USA
6 Division ofHIV, Infectious Diseases andGlobal Medicine,
Department ofMedicine, University ofCalifornia San
Francisco, SanFrancisco, California, USA
7 International Center forAIDS Care andTreatment Program
(ICAP), Columbia University, AddisAbaba, Ethiopia
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
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