Assessment of Disaster Preparedness Associated with Food Insecurity Among Youth Living with HIV in Uganda with Prior Disaster Experience

Background/Purpose:
The burden of HIV/AIDS is intensified by conditions of underdevelopment, food insecurity, and environmental stress. Food insecurity—defined as limited physical, social, and economic access to sufficient, safe, and nutritious food (FAO, 2009)—exacerbates HIV outcomes by impairing antiretroviral therapy (ART) adherence and increases risky sexual behaviors (Tsai et al., 2011; WFP, 2023). In sub-Saharan Africa, where HIV prevalence remains high, the impacts of climate change related disasters further exacerbate food insecurity (Adesete et al., 2022; Logie et al., 2024). Despite recognition of these overlapping vulnerabilities, limited empirical evidence exists on disaster preparedness associated with food insecurity among youth living with HIV (YLHIV) in disaster-prone regions. This pilot study examines food insecurity and disaster readiness among YLHIV in eastern Uganda with recent disaster exposure.

Methods:
This cross-sectional pilot study surveyed a convenience sample of 159 YLHIV, aged 18–26, receiving HIV services at the Bukedi Prevention Institute (Mbale Regional Hospital system) between 2024 and 2025. Ethical approval was granted by the principal investigator’s university (#FY23-24-197) and the local ethics board in Mbale, Uganda. Participants completed a survey questionnaire capturing demographic characteristics, HIV health, food insecurity (Household Food Insecurity Access Scale), social support, disaster experiences, and preparedness. Data were analyzed using Jamovi (v2.3.236). Chi-square tests and multivariate binary logistic regression were used to explore associations between gender, sexual orientation, and disaster-related food insecurity.

Results:
Among the participants, 51.9% identified as male and 48.1% as female with 16.5% as LGBT. Most (92.4%) reported recent exposure to climate-related disasters such as flooding or prolonged drought and often or sometimes lacking access to food. Transactional sex for food was reported by 32.1% during a recent disaster. Over half (52.8%) lacked preparedness for future disasters. Sexual orientation was significantly associated with past transactional sex during a disaster [χ² (1, N=157) = 23.41, p < .0001] and with intentions to seek food assistance from case managers in future events [χ² (1, N=157) = 5.197, p <.05]. Logistic regression showed that experiences such as giving up food due to gender identity or engaging in sex for money strongly predicted transactional sex for food (B = 1.66, SE = 0.77, Wald = 4.68, p = .031, OR = 5.25). The model was statistically significant [χ² (6) = 95.84, p < .001], explaining 46.3%–64.7% of the variance and correctly classifying 85.1% of cases.

Conclusion:
In the context of escalating climate crises and their disproportionate impact on food security, it is critical to integrate disaster preparedness and food assistance strategies into HIV care systems. Social workers and health professionals should prioritize targeted interventions that address both structural vulnerabilities and the intersection of food insecurity, climate risks, and HIV health, particularly for marginalized sexual minorities. Future research should evaluate scalable, climate-resilient livelihood and nutrition support programs for YLHIV in high-risk regions.