Population-Based Study of Food Insecurity and HIV Transmission Risk Behaviors and Symptoms of Sexually Transmitted Infections Among Linked Couples in Nepal
Food insecurity has recently emerged as an important risk factor for HIV acquisition among women worldwide. No previous studies have used linked data that would permit investigation of the extent to which food insecurity may have differential associations with HIV transmission risk behaviors or symptoms of sexually transmitted infections (STIs) among men and women in the same households. We used nationally representative data on linked couples from the Nepal 2011 Demographic and Health Survey. The primary explanatory variable of interest was food insecurity, measured with a modified version of the Household Food Insecurity Access Scale. In multivariable logistic regression models, women in food insecure households were less likely to report recent condom use and more likely to report symptoms consistent with STIs. These patterns were absent among men. Interventions targeting food insecurity may have beneficial implications for both HIV prevention and gender equity in Nepal.
KeywordsFood insecurity Nepal HIV
The authors received no specific financial support for this study. ACT acknowledges salary support from U.S. National Institutes of Health (NIH) K23MH096620 and the Robert Wood Johnson Health and Society Scholars Program. SDW acknowledges salary support from the Hellman Family Foundation and the Burke Family Foundation. Preliminary findings were presented at the Center for AIDS Research Joint Symposium on HIV Research in Women, Providence, RI, September 19, 2012.
- 7.McCoy SI, Ralph LJ, Njau PF, Msolla MM, Padian NS. Food insecurity, socioeconomic status, and HIV-related risk behavior among women in farming households in Tanzania. AIDS Behav. 2013. doi: 10.1007/s10461-013-0629-3.
- 16.Behrman J. Intrahousehold allocation of nutrients in rural India: are boys favored? Do parents exhibit inequality aversion? Oxford Econ Papers. 1988;40(1):32–54.Google Scholar
- 28.Ministry of Health and Population (Nepal). Nepal Country Progress Report 2012. Teku, Kathmandu: National Centre for AIDS and STD Control, Ministry of Health and Population; 2012.Google Scholar
- 31.Suvedi BK. Transition of HIV epidemic in Nepal. Kathmandu Univ Med J (KUMJ). 2006;4(1):115–8.Google Scholar
- 32.Regmi P, Simkhada P, van Teijlingen ER. Sexual and reproductive health status among young peoples in Nepal: opportunities and barriers for sexual health education and services utilization. Kathmandu Univ Med J (KUMJ). 2008;6(2):248–56.Google Scholar
- 35.Joshi NP, Maharjan KL, Piya L. Poverty and food insecurity in Nepal: a review. J Int Dev Coop. 2010;16(2):1–19.Google Scholar
- 36.Ministry of Health and Population (Nepal), New ERA, and ICF International, Inc. Nepal Demographic and Health Survey 2011. Kathmandu: Ministry of Health and Population, New ERA, and ICF International; 2012.Google Scholar
- 38.Osei A, Pandey P, Spiro D, et al. Household food insecurity and nutritional status of children aged 6–23 months in Kailali District of Nepal. Food Nutr Bull. 2010;31(4):483–94.Google Scholar
- 39.Deitchler M, Ballard T, Swindale A, Coates J. Validation of a measure of household hunger for cross-cultural use. Washington, DC: Academy for Educational Development; 2010.Google Scholar
- 40.Williams R. Using the margins command to estimate and interpret adjusted predictions and marginal effects. Stata J. 2012;12(2):308–31.Google Scholar
- 47.Thapa S, Bista N, Timilsina S, Buntinx F, Mathei C. Social and behavioral risk factors for HIV infection among the wives of labor migrants in Nepal. Int J STD AIDS. 2014. doi: 10.1177/0956462414521162.
- 51.Nandini A. Engendered mobilization: the key to livelihood security: IFAD’s experience in South Asia. Rome: International Fund for Agricultural Development; 1999.Google Scholar