title: Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS.
abstract: Food insecurity, which affects >1 billion people worldwide, is inextricably linked to the HIV epidemic. We present a conceptual framework of the multiple pathways through which food insecurity and HIV/AIDS may be linked at the community, household, and individual levels. Whereas the mechanisms through which HIV/AIDS can cause food insecurity have been fairly well elucidated, the ways in which food insecurity can lead to HIV are less well understood. We argue that there are nutritional, mental health, and behavioral pathways through which food insecurity leads to HIV acquisition and disease progression. Specifically, food insecurity can lead to macronutrient and micronutrient deficiencies, which can affect both vertical and horizontal transmission of HIV, and can also contribute to immunologic decline and increased morbidity and mortality among those already infected. Food insecurity can have mental health consequences, such as depression and increased drug abuse, which, in turn, contribute to HIV transmission risk and incomplete HIV viral load suppression, increased probability of AIDS-defining illness, and AIDS-related mortality among HIV-infected individuals. As a result of the inability to procure food in socially or personally acceptable ways, food insecurity also contributes to risky sexual practices and enhanced HIV transmission, as well as to antiretroviral therapy nonadherence, treatment interruptions, and missed clinic visits, which are strong determinants of worse HIV health outcomes. More research on the relative importance of each of these pathways is warranted because effective interventions to reduce food insecurity and HIV depend on a rigorous understanding of these multifaceted relationships.
authors.affiliation: Division of HIV/AIDS, San Francisco General Hospital, USA. sheri.weiser@ucsf.edu
authors.forename: Sheri D
authors.initials: SD
authors.lastname: Weiser
authors.forename: Sera L
authors.initials: SL
authors.lastname: Young
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
authors.forename: Margot B
authors.initials: MB
authors.lastname: Kushel
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Tsai
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Tien
authors.forename: Abigail M
authors.initials: AM
authors.lastname: Hatcher
authors.forename: Edward A
authors.initials: EA
authors.lastname: Frongillo
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D003863:Depression / Q000150:complications; D004032:Diet; D005191:Family Characteristics; D005523:Food Supply; D015658:HIV Infections / Q000150:complications* / Q000401:mortality / Q000635:transmission; D006304:Health Status; D006801:Humans; D007109:Immunity; D044342:Malnutrition / Q000150:complications*; D001523:Mental Disorders / Q000150:complications*; D018977:Micronutrients / Q000172:deficiency*; D009752:Nutritional Status; D010349:Patient Compliance; D012111:Residence Characteristics; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior; D019966:Substance-Related Disorders / Q000150:complications; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D018977:Micronutrients
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