Piloting a Food Security Initiative to Improve Health Disparities Among Individuals Who Are HIV+ and at Risk for Disease Progression

Background and Purpose: Though the HIV/AIDS epidemic in the United States is on the decline, eradication hinges on improved health outcomes among people living with HIV/AIDS (PLWHA). The most powerful way to decrease new infections is to reduce viral loads, among those HIV+, to undetectable levels—where the virus is 96% less likely to be transmitted. Despite the knowledge that antiretroviral therapy (ART) can lead to viral suppression, two major barriers to ART adherence and viral suppression are housing instability and food insecurity—issues of resource equity that highlight needed services for the most vulnerable. Unstably housed people endure greater struggles with ART adherence and are four times more likely to not be virally suppressed. Further, while limited research in the United States has focused on food insecurity among PLWHA, it is cited as a key contributor to the HIV epidemic, given that food insecurity can render ART ineffective.

Because of these specific threats to health outcomes among PWLHA, a Nashville, Tennessee-based AIDS Service Organization (ASO) created the Food Security Initiative (FSI) to ensure the equitable provision of fresh produce to those most at risk for poor health and HIV disease transmission. The purpose of this study was to determine the feasibility and acceptability of administering the FSI so that results can inform future studies over program effectiveness.

Research questions: What is the magnitude of Food Insecurity? What is the level of awareness of client viral loads?

Methods: Cross-sectional data was collected, from November, 2016- February, 2017. Individuals were recruited based either on last lab results showing non-viral suppression (NVS) or those reporting retention issues (homelessness >1 year) (HR). The Health Canada Household Food Security Scale (HCHFSS) was used to measure Food Security levels, and t tests were used to test for group differences.

Results: 53 individuals participated in the study: 56.6% male; 78.4% black, 19.6% white, <2% other. Levels of Food Insecurity were: 73.58% Severe, 20.75% moderate, and 3% secure, with white (t(1, 51)=19.54, p= .000) female (t(1, 52)= 20.86, p= .000) NVS (t(1, 47)= 21.59, p= .000) participants having a significantly higher mean score on the HCHFSS, and those reporting they had an undetectable viral load (54%) having a significantly higher mean score on the HCHFSS than those either reporting their viral load was detectable or unknown (46%) (t(1, 51)= 22.04, p= .000).

Conclusion: Major study findings were the large quantity of food insecurity across the entire sample, and higher food insecurity among white and female participants. Further investigation is needed to understand the phenomena of higher food insecurity among those previously identified as non-virally suppressed compared with the higher food insecurity among those who reported being undetectable. Results also highlight the need for the ASO to develop a standardized protocol for obtaining client’s lab work. Lessons learned from this pilot study will be used to inform a larger scale study that may test the effectiveness of the FSI relative to improvements in viral loads.