title: How food insecurity contributes to poor HIV health outcomes: Qualitative evidence from the San Francisco Bay Area.
abstract: Food-insecure people living with HIV/AIDS (PLHIV) consistently exhibit worse clinical outcomes than their food-secure counterparts. This relationship is mediated in part through non-adherence to antiretroviral therapy (ART), sub-optimal engagement in HIV care, and poor mental health. An in-depth understanding of how these pathways operate in resource-rich settings, however, remains elusive.
  
  
  
  We aimed to understand the relationship between food insecurity and HIV health among low-income individuals in the San Francisco Bay Area using qualitative methods.
  
  
  
  Semi-structured in-depth interviews were conducted with 34 low-income PLHIV receiving food assistance from a non-profit organization. Interviews explored experiences with food insecurity and its perceived effects on HIV-related health, mental health, and health behaviors including taking ART and attending clinics. Thematic content analysis of transcripts followed an integrative inductive-deductive approach.
  
  
  
  Food insecurity was reported to contribute to poor ART adherence and missing scheduled clinic visits through various mechanisms, including exacerbated ART side effects in the absence of food, physical feelings of hunger and fatigue, and HIV stigma at public free-meal sites. Food insecurity led to depressive symptoms among participants by producing physical feelings of hunger, aggravating pre-existing struggles with depression, and nurturing a chronic self-perception of social failure. Participants further explained how food insecurity, depression, and ART non-adherence could reinforce each other in complex interactions.
  
  
  
  Our study demonstrates how food insecurity detrimentally shapes HIV health behavior and outcomes through complex and interacting mechanisms, acting via multiple socio-ecological levels of influence in this setting. The findings emphasize the need for broad, multisectoral approaches to tackling food insecurity among urban poor PLHIV in the United States.
authors: Global Health Sciences, University of California, San Francisco (UCSF), Mission Hall/Global Health and Clinical Sciences Building, 550 16th Street, 3rd Floor, San Francisco, CA 94158-2549, United States. Electronic address: henry.whittle.14@ucl.ac.uk.
authors: Henry J
authors: HJ
authors: Whittle
authors: Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, United States.
authors: Kartika
authors: K
authors: Palar
authors: Center for Vulnerable Populations at San Francisco General Hospital, Division of General Internal Medicine, UCSF, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, United States.
authors: Hilary K
authors: HK
authors: Seligman
authors: Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, United States.
authors: Tessa
authors: T
authors: Napoles
authors: Department of Health Promotion, Education, and Behavior, University of South Carolina, 915 Greene Street, Room 529, Columbia, SC 29208, United States.
authors: Edward A
authors: EA
authors: Frongillo
authors: Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, United States; Center for AIDS Prevention Studies, UCSF, Mission Hall/Global Health and Clinical Sciences Building, 550 16th Street, 3rd Floor, San Francisco, CA 94158-2549, United States.
authors: Sheri D
authors: SD
authors: Weiser
mesh_terms: D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D005260:Female; D063105:Food Assistance / Q000706:statistics & numerical data; D005523:Food Supply / Q000592:standards*; D015658:HIV Infections / Q000191:economics* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D009939:Organizations, Nonprofit / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D036301:Qualitative Research; D012495:San Francisco / Q000453:epidemiology; D012959:Socioeconomic Factors; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents
keywords: ART adherence; Depression; Engagement in care; Food insecurity; HIV; Qualitative research; San Francisco Bay Area; United States