Food insecurity, HIV status and prior testing at South African primary healthcare clinics

Makandwe Nyirenda; Renee Street; Tarylee Reddy; Susie Hoffman; Suraya Dawad; Kelly Blanchard; Theresa M. Exner; Elizabeth A. Kelvin; Joanne E. Mantell; Gita Ramjee

doi:10.17159/sajs.2018/4407

Authors

Makandwe Nyirenda HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
Renee Street 1 HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa 2 Environment and Health Research Unit, South African Medical Research Council, Durban, South Africa http://orcid.org/0000-0002-1983-8968
Tarylee Reddy Biostatistics Unit, South African Medical Research Council, Durban, South Africa
Susie Hoffman 1 Department of Epidemiology, Columbia University, New York, New York, USA 2 HIV Center for Clinical and Behavioural Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
Suraya Dawad 1 HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa 2 National Department of Health, Pretoria, South Africa
Kelly Blanchard Ibis Reproductive Health, Cambridge, Massachusetts, USA
Theresa M. Exner HIV Center for Clinical and Behavioural Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
Elizabeth A. Kelvin 1 Department of Epidemiology and Biostatistics, City University of New York, New York, New York, USA 2 CUNY Institute for Implementation Science in Population Health, City University of New York, New York, New York, USA
Joanne E. Mantell HIV Center for Clinical and Behavioural Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
Gita Ramjee HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa

DOI:

https://doi.org/10.17159/sajs.2018/4407

Keywords:

household food insecurity, HIV counselling, HIV testing, primary health care, South Africa

Abstract

HIV and food insecurity are two prominent causes of morbidity and mortality in sub-Saharan Africa. Food insecurity has been associated with risky sexual practices and poor access to healthcare services. We describe the association between household food insecurity and previous HIV testing and HIV status. We used logistic regression to analyse the association between food insecurity and prior HIV counselling and testing (HCT) and testing HIV positive. A total of 2742 adults who presented for HCT at three primary healthcare clinics in KwaZulu-Natal, South Africa, participated in the study. The prevalence of household food insecurity was 35%. The prevalence of food insecurity was highest in adults who had incomplete high schooling (43%), were unemployed (39%), and whose primary source of income was government grants (50%). Individuals who were food insecure had significantly higher odds of testing HIV positive (adjusted odds ratio 1.41, 95% CI 1.16–1.71), adjusted for demographic and socio-economic variables. There was no association between food insecurity and prior HCT. The findings of this study highlight the important role food insecurity may play in HIV risk. Interventions to turn food-insecure into food-secure households are needed to reduce their household members’ vulnerability to HIV acquisition. The absence of such interventions is likely to severely impact ambitious global targets of ending AIDS by 2030 through the 90-90-90 targets and test-and-treat-all initiatives.

Significance:

One in three adults presenting for HIV counselling and testing came from households with some degree of food insufficiency.
Experience of food insecurity was very high in young people who did not complete high school and were currently not studying.
Findings support the need for socio-economic and structural interventions to transform food-insecure into food-secure households.
Failure or lack of such interventions will contribute to the failure to achieve global targets like the UNAIDS 90-90-90 programme.