title: Food insufficiency is associated with high-risk sexual behavior among women in Botswana and Swaziland.
abstract: BACKGROUND
  Both food insufficiency and HIV infection are major public health problems in sub-Saharan Africa, yet the impact of food insufficiency on HIV risk behavior has not been systematically investigated. We tested the hypothesis that food insufficiency is associated with HIV transmission behavior.
  
  
  RESULTS
  We studied the association between food insufficiency (not having enough food to eat over the previous 12 months) and inconsistent condom use, sex exchange, and other measures of risky sex in a cross-sectional population-based study of 1,255 adults in Botswana and 796 adults in Swaziland using a stratified two-stage probability design. Associations were examined using multivariable logistic regression analyses, clustered by country and stratified by gender. Food insufficiency was reported by 32% of women and 22% of men over the previous 12 months. Among 1,050 women in both countries, after controlling for respondent characteristics including income and education, HIV knowledge, and alcohol use, food insufficiency was associated with inconsistent condom use with a nonprimary partner (adjusted odds ratio [AOR] 1.73, 95% confidence interval [CI] 1.27-2.36), sex exchange (AOR 1.84, 95% CI 1.74-1.93), intergenerational sexual relationships (AOR 1.46, 95% CI 1.03-2.08), and lack of control in sexual relationships (AOR 1.68, 95% CI 1.24-2.28). Associations between food insufficiency and risky sex were much attenuated among men.
  
  
  CONCLUSIONS
  Food insufficiency is an important risk factor for increased sexual risk-taking among women in Botswana and Swaziland. Targeted food assistance and income generation programs in conjunction with efforts to enhance women's legal and social rights may play an important role in decreasing HIV transmission risk for women.
authors.affiliation: Physicians for Human Rights, Cambridge, Massachusetts, USA. Sheri.Weiser@ucsf.edu
authors.forename: Sheri D
authors.initials: SD
authors.lastname: Weiser
authors.forename: Karen
authors.initials: K
authors.lastname: Leiter
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Butler
authors.forename: Fiona
authors.initials: F
authors.lastname: Percy-de Korte
authors.forename: Zakhe
authors.initials: Z
authors.lastname: Hlanze
authors.forename: Nthabiseng
authors.initials: N
authors.lastname: Phaladze
authors.forename: Vincent
authors.initials: V
authors.lastname: Iacopino
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
mesh_terms: D000328:Adult; D001902:Botswana / Q000453:epidemiology; D017280:Condoms / Q000191:economics / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D013541:Eswatini / Q000453:epidemiology; D005260:Female; D005523:Food Supply / Q000191:economics; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology*; D006801:Humans; D006815:Hunger; D007398:Interpersonal Relations; D008297:Male; D044342:Malnutrition / Q000191:economics / Q000453:epidemiology*; D011203:Poverty; D012307:Risk Factors; D012309:Risk-Taking; D011477:Sex Work; D016387:Women's Health