title: Severe food insecurity is associated with elevated unprotected sex among HIV-seropositive injection drug users independent of HAART use.
abstract: OBJECTIVE
  Despite emerging evidence of a significant adverse relationship between food insecurity and sexual risk-taking, data have been primarily derived from resource-constrained settings and HIV-negative populations. To our knowledge, this study is the first to longitudinally evaluate the relationship between food insecurity and unprotected sex among HIV-seropositive people who inject drugs [injection drug users (IDUs)] both on and not on HAART.
  
  
  METHODS
  Longitudinal analyses were restricted to HIV-positive IDUs who completed baseline and at least one follow-up visit in a prospective cohort (AIDS Care Cohort to evaluate Exposure to Survival Services, 2005-2009).
  
  
  METHODS
  We constructed a multivariate logistic model using generalized estimating equations (GEEs) to assess an independent relationship between severe food insecurity (e.g., hunger due to lack of access or means to acquire food) and unprotected vaginal/anal sex.
  
  
  RESULTS
  Among 470 HIV-positive IDUs, the median age was 42 years (interquartile range 36-47) with 61% men and 39% women. The prevalence of severe food insecurity was 71%, with no differences by HAART use. Severe food insecure IDUs were marginally less likely to have a suppressed HIV-1 RNA viral load (31 vs. 39%, P = 0.099). In multivariate GEE analyses, severe food insecurity [adjusted odds ratio = 2.68, 95% confidence interval 1.49-4.82] remained independently correlated with unprotected sex among HIV-positive IDUs, controlling for age, sex/gender, married/cohabitating partner, binge drug use, homelessness, and HAART use.
  
  
  CONCLUSIONS
  These findings highlight a crucial need for structural HIV interventions that incorporate targeted food assistance strategies for IDUs. Given recent evidence of poor virological response among food insecure individuals on HAART, innovative HIV care models should integrate targeted food security programs and early access to HAART.
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada. kshannon@cfenet.ubc.ca
authors.forename: Kate
authors.initials: K
authors.lastname: Shannon
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.forename: M-J
authors.initials: MJ
authors.lastname: Milloy
authors.forename: Aranka
authors.initials: A
authors.lastname: Anema
authors.forename: Ruth
authors.initials: R
authors.lastname: Zhang
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003430:Cross-Sectional Studies; D003625:Data Collection; D005260:Female; D005523:Food Supply / Q000191:economics; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D015497:HIV-1; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012309:Risk-Taking; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D047568:Unsafe Sex / Q000523:psychology / Q000706:statistics & numerical data*; D019562:Viral Load