Abstract
Food insecurity is associated with HIV treatment non-adherence and poor health outcomes for people living with HIV/AIDS. Given the poor nutritional status common to people who drink alcohol, food insecurity may be particularly problematic for HIV positive individuals who drink alcohol. To examine food insecurity among HIV positive men and women who drink alcohol and its association with antiretroviral therapy (ART) adherence, health outcomes and health service utilization. Adults living with HIV (N = 183) in Atlanta, Georgia who reported alcohol use in the previous week and were receiving ART participated in a 12-month cohort. Participants were recruited from infectious disease clinics and social services to complete computerized interviews, monthly-unannounced pill counts to monitor ART adherence, and daily cell-phone delivered interactive-text assessments for alcohol use. Forty-three percent of participants experienced food insecurity during at least one month of the study period. Food insecurity was independently associated with suboptimal ART adherence and less suppressed HIV viral load over. Individuals who experienced food insecurity also had histories of more medical and psychiatric hospitalizations, and greater mental health problems. Food insecurity is prevalent among alcohol using people receiving ART and food insecurity is associated with treatment non-adherence, poor health outcomes, and increased medical and psychiatric hospitalizations.
Similar content being viewed by others
References
Adler, N. E., & Ostrove, J. M. (1999). Socioeconomic status and health: What we know and what we don’t. Annals of the New York Academy of Sciences, 896, 3–15.
Adler, N. E., & Stewart, J. (2010). Health disparities across the lifespan: Meaning, methods, and mechanisms. Annals of the New York Academy of Sciences, 1186, 5–23.
Alghamdi, A. A., Sheth, T., Manowski, Z., Djoleto, O. F., & Bhatnagar, G. (2009). Utility of cardiac CT and MRI for the diagnosis and preoperative assessment of cardiac paraganglioma. Journal of Cardiac Surgery, 24, 700–701.
Bangsberg, D., & Deeks, S. G. (2002). Is average adherence to HIV antiretroviral therapy enough? Journal of General Internal Medicine, 17, 812–813.
Bangsberg, D., Hecht, F. M., Charlebois, E. D., Chesney, M., & Moss, A. (2001). Comparing objective measures of adherence to HIV antiretroviral therapy: Electronic medication monitors and unannounced pill counts. AIDS and Behavior, 5, 275–281.
Bangsberg, D., Kroetz, D. L., & Deeks, S. (2007). Adherence-resistance relationships to combination HIV antiretroviral therapy. Current HIV/AIDS Reports, 4, 65–72.
Cantrell, R. A., Sinkala, M., Megazinni, K., Lawson-Marriott, S., Washington, S., Chi, B. H., et al. (2008). A pilot study of food supplementation to improve adherence to antiretroviral therapy among food-insecure adults in Lusaka, Zambia. Journal of Acquired Immune Deficienct Syndromes, 49, 190–195.
Catz, S. L., Kelly, J. A., Bogart, L. M., Benotsch, E. G., & McAuliffe, T. L. (2000). Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease. Health Psychology, 19, 124–133.
Chesney, M., Folkman, S., & Chambers, D. (1996). Coping effectiveness training for men living with HIV: Preliminary findings. International Journal of STD and AIDS, 7, 75–82.
Coates, J., Swindale, A., & Bilinsky, P. (2007). Household food insecurity access scale (HFIAS) for measurement of food access: Indicator guide USAID. Washington, DC: Academy for Educational Development.
El-Sadr, W. M., Mayer, K. H., & Hodder, S. L. (2010). AIDS in America–forgotten but not gone. New England Journal of Medicine, 362, 967–970.
Franke, M. F., Murray, M. B., Munoz, M., Hernandez-Diaz, S., Sebastian, J. L., Atwood, S., et al. (2011). Food insufficiency is a risk factor for suboptimal antiretroviral therapy adherence among HIV-infected adults in urban Peru. AIDS and Behavior, 15, 1483–1489.
Grymonpre, R. E., Didur, C. D., Montgomery, P. R., & Sitar, D. S. (1998). Pill count, self-report, and pharmacy claims data to measure medication adherence in the elderly. Annals of Pharmacotherapy, 32, 749–754.
Haberer, J. E., Robbins, G. K., Ybarra, M., Monk, A., Ragland, K., Weiser, S. D., et al. (2011). Real-time electronic adherence monitoring is feasible, comparable to unannounced pill counts, and acceptable. AIDS and Behavior, 16, 375–382.
Hendershot, C. S., Stoner, S. A., Pantalone, D. W., & Simoni, J. M. (2009). Alcohol use and antiretroviral adherence: Review and meta-analysis. Journal of Acquired Immune Deficiency Syndromes, 52, 180–202.
Holtgrave, D. R., Wolitski, R. J., Pals, S. L., Aidala, A., Kidder, D. P., Vos, D., et al. (2012). Cost-utility analysis of the housing and health intervention for homeless and unstably housed persons living with HIV. AIDS and Behavior, 17, 1626–1631.
Ivers, L. C., Cullen, K. A., Freedberg, K. A., Block, S., Coates, J., & Webb, P. (2009). HIV/AIDS, undernutrition, and food insecurity. Clinical Infectious Diseases, 49, 1096–1102.
Kalichman, S., Amaral, C. M., Cherry, C., Flanagan, J. A., Pope, H., Eaton, L., et al. (2008). Monitoring antiretroviral adherence by unannounced pill counts conducted by telephone: Reliability and criterion-related validity. HIV Clinical Trials, 9, 298–308.
Kalichman, S., DiMarco, M., Austin, J., Luke, W., & DiFonzo, K. (2003). Stress, social support, and HIV-status disclosure to family and friends among HIV-positive men and women. Journal of Behavioral Medicine, 26, 315–332.
Kalichman, S., Rompa, D., & Cage, M. (2000). Reliability and validity of self-reported CD4 lymphocyte count and viral load test results in people living with HIV/AIDS. International Journal of STD and AIDS, 11, 579–585.
Kim, D. J., Westfall, A. O., Chamot, E., Willig, A. L., Mugavero, M. J., Ritchie, C., et al. (2012). Multimorbidity patterns in HIV-infected patients: The role of obesity in chronic disease clustering. Journal of Acquired Immune Deficiency Syndromes, 15, 600–605.
Kobin, A. B., & Sheth, N. U. (2011). Levels of adherence required for virologic suppression among newer antiretroviral medications. Annals of Pharmacothery, 45, 372–379.
Normen, L., Chan, E. S., Braitstein, P., Annema, A., Bondy, G., & Montaner, J. (2005). Food inseurity and hunger are prevalent among HIV-positive indivudals in Britsh Columbia, Canada. Journal of Nutrition, 135, 820–825.
Parienti, J. J., Das-Douglas, M., Massari, V., Guzman, D., Deeks, S. G., Verdon, R., et al. (2008). Not all missed doses are the same: Sustained NNRTI treatment interruptions predict HIV rebound at low-to-moderate adherence levels. PLoS One, 3(7), e2783.
Saunders, J. B., Aasland, O. G., Babor, T. F., DeLaFuente, J. R., & Grant, M. (1993). Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption II. Addictions, 88, 791–804.
Van Dam, N. T., & Earleywine, M. (2011). Validation of the center for epidemiologic studies depression scale–revised (CESD-R): Pragmatic depression assessment in the general population. Psychiatry Research, 186, 128–132.
van der Sande, M. A., Schim van der Loeff, M. F., Aveika, A. A., Sabally, S., Togun, T., Sarge-Njie, R., et al. (2004). Body mass index at time of HIV diagnosis: A strong and independent predictor of survival. Journal of Acquired Immune Deficiency Syndromrd, 37, 1288–1294.
Vogenthaler, N. S., Hadley, C., Rodriguez, A. E., Valverde, E. E., del Rio, C., & Metsch, L. R. (2011). Depressive symptoms and food insufficiency among HIV-infected crack users in Atlanta and Miami. AIDS and Behavior, 15, 1520–1526.
Weiser, S. D., Bangsberg, D. R., Kegeles, S., Ragland, K., Kushel, M. B., & Frongillo, E. A. (2009a). Food insecurity among homeless and marginally housed individuals living with HIV/AIDS in San Francisco. AIDS and Behavior, 13, 841–848.
Weiser, S. D., Fernandes, K. A., Brandson, E. K., Lima, V. D., Anema, A., Bangsberg, D. R., et al. (2009b). The association between food insecurity and mortality among HIV-infected individuals on HAART. Journal of Acquired Immune Deficiency Syndromes, 52, 349–352.
Weiser, S. D., Frongillo, E. A., Ragland, K., Hogg, R. S., Riley, E. D., & Bangsberg, D. R. (2009c). Food insecurity is associated with incomplete HIV RNA suppression among homeless and marginally housed HIV-infected individuals in San Francisco. Journal of General Internal Medicine, 24, 14–20.
Weiser, S. D., Hatcher, A., Frongillo, E. A., Guzman, D., Riley, E. D., Bangsberg, D. R., et al. (2012a). Food insecurity is associated with greater acute care utilization among HIV-infected homeless and marginally housed individuals in San Francisco. Journal of General Internal Medicine, 28, 91–98.
Weiser, S. D., Tsai, A. C., Gupta, R., Frongillo, E. A., Kawuma, A., Senkungu, J., et al. (2012b). Food insecurity is associated with morbidity and patterns of healthcare utilization among HIV-infected individuals in a resource-poor setting. AIDS, 26, 67–75.
Acknowledgments
This research was supported by an America Reinvestment and Recovery Act (ARRA) Challenge Grant from the National Institute of Alcohol Abuse and Alcoholism (NIAAA) RC1AA018983.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kalichman, S.C., Grebler, T., Amaral, C.M. et al. Food insecurity and antiretroviral adherence among HIV positive adults who drink alcohol. J Behav Med 37, 1009–1018 (2014). https://doi.org/10.1007/s10865-013-9536-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10865-013-9536-3