title: Relationship between food insecurity and mortality among HIV-positive injection drug users receiving antiretroviral therapy in British Columbia, Canada.
abstract: OBJECTIVE
  Little is known about the potential impact of food insecurity on mortality among people living with HIV/AIDS. We examined the potential relationship between food insecurity and all-cause mortality among HIV-positive injection drug users (IDU) initiating antiretroviral therapy (ART) across British Columbia (BC).
  
  
  METHODS
  Cross-sectional measurement of food security status was taken at participant ART initiation. Participants were prospectively followed from June 1998 to September 2011 within the fully subsidized ART program. Cox proportional hazard models were used to ascertain the association between food insecurity and mortality, controlling for potential confounders.
  
  
  RESULTS
  Among 254 IDU, 181 (71.3%) were food insecure and 108 (42.5%) were hungry. After 13.3 years of median follow-up, 105 (41.3%) participants died. In multivariate analyses, food insecurity remained significantly associated with mortality (adjusted hazard ratio [AHR] = 1.95, 95% CI: 1.07-3.53), after adjusting for potential confounders.
  
  
  CONCLUSIONS
  HIV-positive IDU reporting food insecurity were almost twice as likely to die, compared to food secure IDU. Further research is required to understand how and why food insecurity is associated with excess mortality in this population. Public health organizations should evaluate the possible role of food supplementation and socio-structural supports for IDU within harm reduction and HIV treatment programs.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada. aanema@cfenet.ubc.ca
authors.forename: Aranka
authors.initials: A
authors.lastname: Anema
authors.forename: Keith
authors.initials: K
authors.lastname: Chan
authors.forename: Yalin
authors.initials: Y
authors.lastname: Chen
authors.forename: Sheri
authors.initials: S
authors.lastname: Weiser
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001955:British Columbia / Q000453:epidemiology; D055030:Drug Users; D005260:Female; D005523:Food Supply; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis
chemical_list: D019380:Anti-HIV Agents