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The social context of food insecurity among persons living with HIV/AIDS in rural Uganda

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  • Tsai, Alexander C.
  • Bangsberg, David R.
  • Emenyonu, Nneka
  • Senkungu, Jude K.
  • Martin, Jeffrey N.
  • Weiser, Sheri D.

Abstract

HIV/AIDS and food insecurity are two of the leading causes of morbidity and mortality in sub-Saharan Africa, with each heightening the vulnerability to, and worsening the severity of, the other. Less research has focused on the social determinants of food insecurity in resource-limited settings, including social support and HIV-related stigma. In this study, we analyzed data from a cohort of 456 persons from the Uganda AIDS Rural Treatment Outcomes study, an ongoing prospective cohort of persons living with HIV/AIDS (PLWHA) initiating HIV antiretroviral therapy in Mbarara, Uganda. Quarterly data were collected by structured interviews. The primary outcome, food insecurity, was measured with the Household Food Insecurity Access Scale. Key covariates of interest included social support, internalized HIV-related stigma, HIV-related enacted stigma, and disclosure of HIV serostatus. Severe food insecurity was highly prevalent overall (38%) and more prevalent among women than among men. Social support, HIV disclosure, and internalized HIV-related stigma were associated with food insecurity; these associations persisted after adjusting for household wealth, employment status, and other previously identified correlates of food insecurity. The adverse effects of internalized stigma persisted in a lagged specification, and the beneficial effect of social support further persisted after the inclusion of fixed effects. International organizations have increasingly advocated for addressing food insecurity as part of HIV/AIDS programming to improve morbidity and mortality. This study provides quantitative evidence on social determinants of food insecurity among PLWHA in resource-limited settings and suggests points of intervention. These findings also indicate that structural interventions to improve social support and/or decrease HIV-related stigma may also improve the food security of PLWHA.

Suggested Citation

  • Tsai, Alexander C. & Bangsberg, David R. & Emenyonu, Nneka & Senkungu, Jude K. & Martin, Jeffrey N. & Weiser, Sheri D., 2011. "The social context of food insecurity among persons living with HIV/AIDS in rural Uganda," Social Science & Medicine, Elsevier, vol. 73(12), pages 1717-1724.
    • Handle: RePEc:eee:socmed:v:73:y:2011:i:12:p:1717-1724
    DOI: 10.1016/j.socscimed.2011.09.026
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    6. Tia Palermo & Rahul Rawat & Sheri D Weiser & Suneetha Kadiyala, 2013. "Food Access and Diet Quality Are Associated with Quality of Life Outcomes among HIV-Infected Individuals in Uganda," PLOS ONE, Public Library of Science, vol. 8(4), pages 1-11, April.
    7. Nyantakyi-Frimpong, Hanson & Mambulu, Faith Nankasa & Bezner Kerr, Rachel & Luginaah, Isaac & Lupafya, Esther, 2016. "Agroecology and sustainable food systems: Participatory research to improve food security among HIV-affected households in northern Malawi," Social Science & Medicine, Elsevier, vol. 164(C), pages 89-99.
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    13. Zekeri, Andrew A. & Diabate, Youssouf, 2014. "Food Insecurity And Psychological Well-Being Among Women Living With Hiv/Aids On Antiretroviral Therapy In The Alabama Black Belt," Professional Agricultural Workers Journal (PAWJ), Professional Agricultural Workers Conference, vol. 2(1), pages 1-9.
    14. L. J. S. Baiyegunhi & B. B. Oppong & G. M. Senyolo, 2016. "Mopane worm (Imbrasia belina) and rural household food security in Limpopo province, South Africa," Food Security: The Science, Sociology and Economics of Food Production and Access to Food, Springer;The International Society for Plant Pathology, vol. 8(1), pages 153-165, February.
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    16. Conroy, Amy A. & McKenna, Stacey A. & Comfort, Megan L. & Darbes, Lynae A. & Tan, Judy Y. & Mkandawire, James, 2018. "Marital infidelity, food insecurity, and couple instability: A web of challenges for dyadic coordination around antiretroviral therapy," Social Science & Medicine, Elsevier, vol. 214(C), pages 110-117.

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