Food insecurity robs good outcome of quality HIV care
If people living with HIV (PLHIV) are food insecure, then we alarmingly lose the desired good outcomes of quality HIV treatment and care. This was powerfully articulated and backed by evidence in the session of Dr Christine Wanke, Director, Division of Nutrition and Infection, Tufts University School of Medicine in Boston, USA. She was speaking at the recently concluded Chennai ART Symposium (CART 2011).
CART 2011 was organized in Chennai, India (8-9 January 2011) by Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), in collaboration with Centre for AIDS Research (CFAR), Brown University, National Institute of Health (NIH), University of California (San Diego), Karolinska Institute, and HIV Medicine Association of India (HIVMAI).
Food insecurity among PLHIV worsens viral suppression and lowers CD4 count, thereby, exacerbating HIV related morbidity and mortality, said Dr Wanke. She explained in details the cross-cutting issues and how it impacts HIV treatment and care outcomes if food security is undermined.
Food insecurity might present in different forms in different people which may include macronutrient and micronutrient deficiencies, ART interactions, obesity, lipodystrophy, range of mental health concerns, and more importantly, behavioural outcomes that can adversely impact ART adherence, missed clinic visits and treatment interruptions. If so, then no wonder with food insecurity, HIV treatment and care outcomes will be seriously compromised.
According to a study done by Hopers Foundation (Sahai Trust) in Chennai, India, much more severe food insecurity was found in PLHIV when compared to HIV negative population in the same communities. Up to two fold food insecurity was found in HIV positive injecting-drug-users (IDUs) when compared to food insecurity faced by HIV negative population in same vicinity.
Not just Chennai study outcomes but many other studies done in other countries also present similar data – where food insecurity is found to be high in HIV positive people. For instance, in a study done among HIV positive and HIV negative IDUs in Viet Nam, 5% of them who were HIV positive were food insecure, compared to 2% of HIV negative IDUs who were food insecure.
Another important fact Dr Wanke stated was that there is no correlation between body mass index (BMI) and food security. In a study done in Kenya, BMI was similar in four groups, but food security was different, said Dr Wanke.
In a study done on HIV positive women in Nairobi, Kenya, 25% women reported that they have not eaten for an entire day due to lack of food and 27% women reported that they have gone to bed hungry at night.
Most striking was the study outcome that one out of eight reasons given by women living with HIV for not willing to take the antiretroviral therapy (ART) was that they weren’t sure about getting enough food – so apprehending food insecurity, they denied getting on an available therapy that would have possibly given them a heightened quality of life and longevity.
Dr Wanke also outlined many direct benefits of food security on a population – not associated with HIV directly – but surely impacting HIV programme performance in a positive manner.