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Food Insecurity, Substance Use, and Sexual Transmission Risk Behavior Among People Living with HIV: A Daily Level Analysis

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Abstract

People living with HIV in poverty have limited tangible and mental resources coupled with competing demands for these resources. Competing demands require individuals to make choices that may be beneficial to them in the short term but not in the long term. Past research has shown that food insecurity is related to sexual risk behaviors among people living with HIV. Individuals who are food insecure may sell sex in order to obtain food or lack of food may lead to a depletion of mental resources to negotiate safe sex. Substance use may also create additional constraints on these already limited resources. The current study tested the relation between food insecurity and day-level sexual risk behavior and the possible mediating role that alcohol/substance use may play. Men and women living with HIV were enrolled in a 28-day prospective study between October 2012 and April 2014 in which they completed daily text message surveys regarding their sex behaviors and substance/alcohol use in the context of sex. A total of 796 participants reported sex on 3894 days. On days in which sex occurred, baseline food insecurity was negatively associated with daily condom use. There was also a significant effect of substance use in the context of sex on the rates of change in condom use over time, and this interaction between substance use and time was a partial mediator of the relation between food insecurity and condom use. Gender did not moderate this mediation. Situation-specific alcohol and drug use should be integrated into interventions that target food insecurity and HIV prevention.

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Funding

This study was funded by the National Institute on Drug Abuse (R01DA033067) and the National Institute of Mental Health (T32 MH074387 and T32 MH078788).

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Authors and Affiliations

  1. Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, 121 South Main Street, 2nd Floor, Providence, RI, 02903, USA

    Jennifer A. Pellowski

  2. Department of Allied Health Sciences and Department of Statistics, University of Connecticut, Storrs, CT, USA

    Tania B. Huedo-Medina

  3. Department of Psychology, University of Connecticut, Storrs, CT, USA

    Seth C. Kalichman

Authors
  1. Jennifer A. Pellowski
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  2. Tania B. Huedo-Medina
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  3. Seth C. Kalichman
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Correspondence to Jennifer A. Pellowski.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Pellowski, J.A., Huedo-Medina, T.B. & Kalichman, S.C. Food Insecurity, Substance Use, and Sexual Transmission Risk Behavior Among People Living with HIV: A Daily Level Analysis. Arch Sex Behav 47, 1899–1907 (2018). https://doi.org/10.1007/s10508-017-0942-4

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  • DOI: https://doi.org/10.1007/s10508-017-0942-4

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