Food insecurity and sexual risk in an HIV endemic community in Uganda.
Food insecurity has been linked to high-risk sexual behavior in sub-Saharan Africa, but there are limited data on these links among people living with HIV/AIDS, and on the mechanisms for how food insecurity predisposes individuals to risky sexual practices. We undertook a series of in-depth open-ended interviews with 41 individuals living with HIV/AIDS to understand the impact of food insecurity on sexual-risk behaviors. Participants were recruited from the Immune Suppression Clinic at the Mbarara University of Science and Technology in Mbarara, Uganda. Interviews were recorded, transcribed verbatim, translated, and coded following the strategy of grounded theory. Four major themes emerged from the interview data: the relationship between food insecurity and transactional sex for women; the impact of a husband's death from HIV on worsening food insecurity among women and children; the impact of food insecurity on control over condom use, and the relationship between food insecurity and staying in violent/abusive relationships. Food insecurity led to increased sexual vulnerability among women. Women were often compelled to engage in transactional sex or remain in violent or abusive relationships due to their reliance on men in their communities to provide food for themselves and their children. There is an urgent need to prioritize food security programs for women living with HIV/AIDS and address broader gender-based inequities that are propelling women to engage in risky sexual behaviors based on hunger. Such interventions will play an important role in improving the health and well-being of people living with HIV/AIDS, and preventing HIV transmission.
Miller
Cari L
CL
Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
Bangsberg
David R
DR
Tuller
David M
DM
Senkungu
Jude
J
Kawuma
Annet
A
Frongillo
Edward A
EA
Weiser
Sheri D
SD
D000328:Adult; D017280:Condoms / Q000191:economics / Q000706:statistics & numerical data; D019353:Endemic Diseases; D005260:Female; D005523:Food Supply; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D006815:Hunger; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012309:Risk-Taking; D011477:Sex Work; D012725:Sexual Behavior / Q000523:psychology*; D012959:Socioeconomic Factors; D014454:Uganda / Q000453:epidemiology; D014754:Violence; D055815:Young Adult
AIDS Behav. 2010 Feb;14(1):103-12
19051003
Soc Sci Med. 2001 Feb;52(4):509-18
11206649
J Health Popul Nutr. 2005 Jun;23(2):105-20
16117362
Soc Sci Med. 2007 Sep;65(6):1235-48
17560702
AIDS Care. 2006 Oct;18(7):656-62
16971272
Afr Health Sci. 2005 Dec;5(4):328-34
16615845
Prev Sci. 2009 Sep;10(3):260-9
19353267
Philos Trans R Soc Lond B Biol Sci. 2005 Nov 29;360(1463):2169-82
16433102
Ann N Y Acad Sci. 2008;1136:101-10
17954681
Soc Sci Med. 2002 Feb;54(3):325-37
11824910
PLoS Med. 2007 Oct;4(10):1589-97; discussion 1598
17958460
East Afr Med J. 2005 Jan;82(1):40-6
16122111
Lancet. 2008 Aug 23;372(9639):669-84
18687459
Am J Occup Ther. 1991 Mar;45(3):214-22
2031523
Am J Public Health. 2002 Aug;92(8):1331-7
12144993
SAHARA J. 2007 Aug;4(2):626-35
18071614
AIDS Care. 2007 Sep;19(8):974-81
17851993
BMJ. 2005 Oct 1;331(7519):769-72
16195298
J Acquir Immune Defic Syndr. 2009 Nov 1;52(3):342-9
19675463
Lancet. 2006 Dec 2;368(9551):1973-83
17141704
Soc Sci Med. 2005 Feb;60(3):649-60
15550312
Am J Public Health. 2007 Jan;97(1):13-8
17138923
Afr Health Sci. 2005 Sep;5(3):188-97
16245988
Afr J Reprod Health. 2007 Dec;11(3):62-82
18458747
Can J Diet Pract Res. 2004 Fall;65(3):132-5
15455476
Glob Public Health. 2009;4(2):169-82
19333807
Proc Nutr Soc. 2008 Feb;67(1):105-8
18234138
J Nutr. 2005 Apr;135(4):820-5
15795441
AIDS. 2008 Dec;22 Suppl 4:S17-25
19033752
Health Care Women Int. 2002 Feb;23(2):173-84
11868964
BMC Public Health. 2007 Jan 17;7:6
17229324
J Perinat Educ. 2003 Winter;12(1):42-7
17273329