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Food insecurity is associated with HIV, sexually transmitted infections and drug use among men in the United States

Palar, Kartika; Laraia, Barbara; Tsai, Alexander C.; Johnson, Mallory O.; Weiser, Sheri D.

doi: 10.1097/QAD.0000000000001095
Epidemiology and Social

Objective: To examine the population-level association between food insecurity, HIV risk factors, and HIV serostatus among men, the group representing the majority of HIV diagnoses in the United States.

Design: Cross-sectional secondary data analysis using the National Health and Nutrition Examination Survey 1999–2012, a nationally representative survey of the civilian noninstitutionalized US population.

Methods: Logistic regression with design weights and complex survey commands was used to estimate nationally representative associations between food insecurity and HIV serostatus (primary outcome), herpes simplex virus 2, self-reported sexually transmitted infections (STIs), and past-year illicit drug use among men, adjusting for potential confounders. Food security was measured using the 18-item Household Food Security Survey.

Results: We analyzed data for 9150 men representing 61 million individuals in the United States. Unadjusted HIV prevalence was 1.5% among food insecure men, compared with 0.4% among food secure men (P < 0.001). In adjusted models, food insecure men had over two times higher odds of HIV seropositivity compared with food secure men [adjusted odds ratio (AOR) = 2.10; 95% confidence interval (CI) 1.01–4.37; P < 0.05]. Food insecurity was associated with higher odds of herpes simplex virus 2 seropositivity (AOR = 1.28; 95% CI 1.04–1.57; P < 0.05), self-reported STIs (AOR = 1.54; 95% CI 1.08–2.20; P < 0.05), and illicit drug use (AOR = 1.57; 95% CI 1.14–2.15; P < 0.01). Results were robust to sensitivity analyses restricted to lower incomes.

Conclusion: Food insecurity is associated with prevalent HIV, STIs, and illicit drug use among men in the United States. Further research is needed to establish whether and through what mechanisms improved food security may help prevent new HIV infections.

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aDepartment of Medicine, Division of HIV, Infectious Disease (ID) and Global Medicine, University of California, San Francisco (UCSF), San Francisco

bSchool of Public Health, University of California, Berkeley, Berkeley, California

cMassachusetts General Hospital, MGH Global Health, Boston, Massachusetts

dCenter for AIDS Prevention Studies, Department of Medicine, UCSF, San Francisco, USA.

Correspondence to Kartika Palar, PhD, Department of Medicine, Division of HIV, ID and Global Medicine at San Francisco General Hospital, UCSF, San Francisco, CA, USA. E-mail:

Received 7 October, 2015

Revised 26 February, 2016

Accepted 7 March, 2016

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