Abstract
HIV and food insecurity are two prominent causes of morbidity and mortality in sub-Saharan Africa. Food insecurity has been associated with risky sexual practices and poor access to healthcare services. We describe the association between household food insecurity and previous HIV testing and HIV status. We used logistic regression to analyse the association between food insecurity and prior HIV counselling and testing (HCT) and testing HIV positive. A total of 2742 adults who presented for HCT at three primary healthcare clinics in KwaZulu-Natal, South Africa, participated in the study. The prevalence of household food insecurity was 35%. The prevalence of food insecurity was highest in adults who had incomplete high schooling (43%), were unemployed (39%), and whose primary source of income was government grants (50%). Individuals who were food insecure had significantly higher odds of testing HIV positive (adjusted odds ratio 1.41, 95% CI 1.16–1.71), adjusted for demographic and socio-economic variables. There was no association between food insecurity and prior HCT. The findings of this study highlight the important role food insecurity may play in HIV risk. Interventions to turn food-insecure into food-secure households are needed to reduce their household members’ vulnerability to HIV acquisition. The absence of such interventions is likely to severely impact ambitious global targets of ending AIDS by 2030 through the 90-90-90 targets and test-and-treat-all initiatives.
 Significance: 
 
 One in three adults presenting for HIV counselling and testing came from households with some degree of food insufficiency.
 Experience of food insecurity was very high in young people who did not complete high school and were currently not studying.
 Findings support the need for socio-economic and structural interventions to transform food-insecure into food-secure households.
 Failure or lack of such interventions will contribute to the failure to achieve global targets like the UNAIDS 90-90-90 programme.
Highlights
To end AIDS as a global pandemic by 2030, UNAIDS has set the world ambitious targets of 90-90-90.1 That is, by 2020, 90% of all persons living with HIV will be tested and know their status; of those tested positive, 90% will be on antiretroviral treatment; and 90% of those on antiretroviral treatment will achieve viral suppression
We found that household food insecurity was not significantly associated with history of previous HIV testing (OR=0.95, 95% confidence interval (CI)=0.80–1.12, p=0.520)
We examined the links between household food insecurity and previous HIV testing and testing HIV positive to ascertain if food insecurity is a barrier to HIV testing or a risk factor for HIV infection
Summary
To end AIDS as a global pandemic by 2030, UNAIDS has set the world ambitious targets of 90-90-90.1 That is, by 2020, 90% of all persons living with HIV will be tested and know their status; of those tested positive, 90% will be on antiretroviral treatment; and 90% of those on antiretroviral treatment will achieve viral suppression. HIV counselling and testing (HCT) is the initial step in the cascade of HIV prevention, care and treatment towards ending HIV as a public health pandemic.[1,2] A number of factors have been identified as contributory to the low uptake of HIV testing services including hunger, poor nutrition and food insecurity.[3] In South Africa, the recent National Health and Nutrition Examination Survey revealed that 28% of the population are at risk of hunger and 26% are household food insecure (ever experienced hunger).[4]. Much of the empirical research focus has been on the relationship between food insecurity and the health and well-being of HIV-infected persons.[5,6,7,8,9] Food insecurity has been shown to be associated with poor health and poor adherence to medication, including antiretroviral drugs.[10,11,12] In South Africa, one of the main reasons cited for not accepting free antiretroviral drugs was fear of taking medication on an empty stomach as a consequence of food insufficiency.[13,14] In Tanzania, supplementary food cost was cited as an access challenge in sustaining long-term antiretroviral treatment.[15]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
