AIDS and Behavior

, Volume 21, Issue 12, pp 3473–3477 | Cite as

Food Insecurity is Associated with Poor HIV Outcomes Among Women in the United States

  • Matthew A. Spinelli
  • Edward A. Frongillo
  • Lila A. Sheira
  • Kartika Palar
  • Phyllis C. Tien
  • Tracey Wilson
  • Daniel Merenstein
  • Mardge Cohen
  • Adebola Adedimeji
  • Eryka Wentz
  • Adaora A. Adimora
  • Lisa R. Metsch
  • Janet M. Turan
  • Margot B. Kushel
  • Sheri D. Weiser
Brief Report


Women in the general population experience more food insecurity than men. Few studies have examined food insecurity’s impact on HIV treatment outcomes among women. We examined the association between food insecurity and HIV outcomes in a multi-site sample of HIV-infected women in the United States (n = 1154). Two-fifths (40%) of participants reported food insecurity. In an adjusted multivariable Tobit regression model, food insecurity was associated with 2.08 times higher viral load (95% confidence interval (CI): 1.04, 4.15) and lower CD4+ counts (− 42.10, CI: − 81.16, − 3.03). Integration of food insecurity alleviation into HIV programs may improve HIV outcomes in women.


Food insecurity Women HIV Viral load 


Las mujeres dentro de la población general experimentan inseguridad alimentaria con mayor frecuencia que los hombres. Pocos estudios han examinado el impacto de la inseguridad alimentaria en los resultados del tratamiento de VIH en las mujeres. En este estudio, examinamos la relación entre la inseguridad alimentaria y los resultados del tratamiento de VIH en una muestra de varios sitios de mujeres infectadas con el VIH en los Estados Unidos (n = 1154). Dos quintas partes (40%) de las participantes reportaron inseguridad alimentaria. En un modelo de regresión múltiple Tobit ajustado, la inseguridad alimentaria se asoció con una carga viral 2.08 veces mayor (95% intervalo de confianza (IC): 1.04, 4.15). La inseguridad alimentaria se asoció con menores células CD4+ (-42.10, IC: -81.16, -3.03). La integración del alivio de la inseguridad alimentaria en los programas de VIH puede mejorar los resultados clínicos de las mujeres.



This project was funded by NIH R01MH095683. Data in this manuscript were collected by the Women’s Interagency HIV Study (WIHS). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). WIHS (Principal Investigators): UAB-MS WIHS (Michael Saag, Mirjam-Colette Kempf, and Deborah Konkle-Parker), U01-AI-103401; Atlanta WIHS (Ighovwerha Ofotokun and Gina Wingood), U01-AI-103408; Bronx WIHS (Kathryn Anastos), U01-AI-035004; Brooklyn WIHS (Howard Minkoff and Deborah Gustafson), U01-AI-031834; Chicago WIHS (Mardge Cohen and Audrey French), U01-AI-034993; Metropolitan Washington WIHS (Seble Kassaye), U01-AI-034994; Miami WIHS (Margaret Fischl and Lisa Metsch), U01-AI-103397; UNC WIHS (Adaora Adimora), U01-AI-103390; Connie Wofsy Women’s HIV Study, Northern California (Ruth Greenblatt, Bradley Aouizerat, and Phyllis Tien), U01-AI-034989; WIHS Data Management and Analysis Center (Stephen Gange and Elizabeth Golub), U01-AI-042590; Southern California WIHS (Alexandra Levine and Marek Nowicki), U01-HD-032632 (WIHS I–WIHS IV). The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women’s Health. WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA) and UL1-TR000454 (Atlanta CTSA).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

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.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10461_2017_1968_MOESM1_ESM.docx (25 kb)
Supplementary material 1 (DOCX 25 kb)


  1. 1.
    Weiser SD, Young SL, Cohen CR, Kushel MB, Tsai AC, Tien PC, et al. Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. Am J Clin Nutr. 2011;94(6):1729S–39S.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Feldman MB, Alexy ER, Thomas JA, Gambone GF, Irvine MK. The association between food insufficiency and HIV treatment outcomes in a longitudinal analysis of HIV-infected individuals in New York City. J Acquir Immune Defic Syndr. 2015;69(3):329–37.CrossRefPubMedGoogle Scholar
  3. 3.
    Weiser SD, Yuan C, Guzman D, Frongillo EA, Riley ED, Bangsberg DR, et al. Food insecurity and HIV clinical outcomes in a longitudinal study of urban homeless and marginally housed HIV-infected individuals. AIDS. 2013;27(18):2953–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Weiser SD, Palar K, Frongillo EA, Tsai AC, Kumbakumba E, Depee S, et al. Longitudinal assessment of associations between food insecurity, antiretroviral adherence and HIV treatment outcomes in rural Uganda. AIDS. 2014;28(1):115–20.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Wang EA, McGinnis KA, Fiellin DA, Goulet JL, Bryant K, Gibert CL, et al. Food insecurity is associated with poor virologic response among HIV-infected patients receiving antiretroviral medications. J Gen Intern Med. 2011;26(9):1012–8.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Hernandez DC, Reesor L, Murillo R. Gender disparities in the food insecurity-overweight and food insecurity-obesity paradox among low-income older adults. J Acad Nutr Diet. 2017;. Scholar
  7. 7.
    Bacon MC, von Wyl V, Alden C, Sharp G, Robison E, Hessol N, et al. The Women’s Interagency HIV Study: an observational cohort brings clinical sciences to the bench. Clin Diagn Lab Immunol. 2005;12(9):1013–9.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Frongillo EA, Nanama S. Development and validation of an experience-based measure of household food insecurity within and across seasons in northern Burkina Faso. J Nutr. 2006;136(5):1409S–19S.PubMedGoogle Scholar
  9. 9.
    Young S, Wheeler AC, McCoy SI, Weiser SD. A review of the role of food insecurity in adherence to care and treatment among adult and pediatric populations living with HIV and AIDS. AIDS Behav. 2014;18(Suppl 5):S505–15.CrossRefPubMedGoogle Scholar
  10. 10.
    Coleman-Jensen A, Rabbit MP, Gregory CA, Singh A. Household food security in the United States in 2015. Washington, DC: U.S. Department of Agriculture, Economic Research Service; 2016.Google Scholar
  11. 11.
    Martinez H, Palar K, Linnemayr S, Smith A, Derose KP, Ramirez B, et al. Tailored nutrition education and food assistance improve adherence to HIV antiretroviral therapy: evidence from Honduras. AIDS Behav. 2014;18(Suppl 5):S566–77.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Palar K, Napoles T, Hufstedler LL, Seligman H, Hecht FM, Madsen K, et al. Comprehensive and medically appropriate food support is associated with improved HIV and diabetes health. J Urban Health. 2017;94(1):87–99.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Matthew A. Spinelli
    • 1
  • Edward A. Frongillo
    • 2
  • Lila A. Sheira
    • 3
  • Kartika Palar
    • 3
  • Phyllis C. Tien
    • 4
  • Tracey Wilson
    • 5
  • Daniel Merenstein
    • 6
  • Mardge Cohen
    • 7
  • Adebola Adedimeji
    • 8
  • Eryka Wentz
    • 9
  • Adaora A. Adimora
    • 10
  • Lisa R. Metsch
    • 11
  • Janet M. Turan
    • 12
  • Margot B. Kushel
    • 13
  • Sheri D. Weiser
    • 3
  1. 1.Division of Infectious DiseaseUniversity of CaliforniaSan FranciscoUSA
  2. 2.Department of Health Promotion, Education, and BehaviorUniversity of South CarolinaColumbiaUSA
  3. 3.Division of HIV, ID and Global Medicine, Department of MedicineUniversity of California, San Francisco (UCSF)San FranciscoUSA
  4. 4.Department of MedicineUniversity of California, San Francisco and Medical Service, Department of Veteran Affairs Medical CenterSan FranciscoUSA
  5. 5.Department of Community Health SciencesState University of New York Downstate Medical Center, School of Public HealthBrooklynUSA
  6. 6.Department of Family MedicineGeorgetown University Medical CenterWashingtonUSA
  7. 7.Department of MedicineStroger HospitalChicagoUSA
  8. 8.Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxUSA
  9. 9.Bloomberg School of Public Health, Department of EpidemiologyJohns Hopkins UniversityBaltimoreUSA
  10. 10.School of Medicine and UNC Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  11. 11.Department of Sociomedical Sciences, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  12. 12.Department of Health Care Organization and Policy, School of Public HealthUniversity of Alabama at BirminghamBirminghamUSA
  13. 13.Division of General Internal Medicine, Zuckerberg San Francisco General HospitalUniversity of California, San Francisco (UCSF)San FranciscoUSA

Personalised recommendations