Robert Wood Johnson Health and Society Scholars Program, Harvard University, Cambridge, Massachusetts, USA.
PLoS Med. 2012;9(4):e1001203. doi: 10.1371/journal.pmed.1001203. Epub 2012 Apr 10.
Understanding how food insecurity among women gives rise to differential patterning in HIV risks is critical for policy and programming in resource-limited settings. This is particularly the case in Brazil, which has undergone successive changes in the gender and socio-geographic composition of its complex epidemic over the past three decades. We used data from a national survey of Brazilian women to estimate the relationship between food insecurity and HIV risk.
We used data on 12,684 sexually active women from a national survey conducted in Brazil in 2006-2007. Self-reported outcomes were (a) consistent condom use, defined as using a condom at each occasion of sexual intercourse in the previous 12 mo; (b) recent condom use, less stringently defined as using a condom with the most recent sexual partner; and (c) itchy vaginal discharge in the previous 30 d, possibly indicating presence of a sexually transmitted infection. The primary explanatory variable of interest was food insecurity, measured using the culturally adapted and validated Escala Brasiliera de Segurança Alimentar. In multivariable logistic regression models, severe food insecurity with hunger was associated with a reduced odds of consistent condom use in the past 12 mo (adjusted odds ratio [AOR] = 0.67; 95% CI, 0.48-0.92) and condom use at last sexual intercourse (AOR = 0.75; 95% CI, 0.57-0.98). Self-reported itchy vaginal discharge was associated with all categories of food insecurity (with AORs ranging from 1.46 to 1.94). In absolute terms, the effect sizes were large in magnitude across all outcomes. Underweight and/or lack of control in sexual relations did not appear to mediate the observed associations.
Severe food insecurity with hunger was associated with reduced odds of condom use and increased odds of itchy vaginal discharge, which is potentially indicative of sexually transmitted infection, among sexually active women in Brazil. Interventions targeting food insecurity may have beneficial implications for HIV prevention in resource-limited settings.
了解女性的粮食不安全如何导致艾滋病毒风险的差异模式，对于资源有限环境中的政策和规划至关重要。在巴西，这种情况尤其如此，过去三十年中，其复杂的艾滋病疫情在性别和社会地理构成方面经历了连续变化。我们使用了来自巴西全国妇女调查的数据来估计粮食不安全与艾滋病毒风险之间的关系。
我们使用了 2006-2007 年在巴西进行的全国调查中 12684 名活跃女性的数据。自我报告的结果包括：（a）一致性避孕套使用，定义为在过去 12 个月内每次性行为中都使用避孕套；（b）最近使用避孕套，定义较宽松，为与最近性伴侣发生性行为时使用避孕套；（c）过去 30 天内阴道瘙痒，可能表明存在性传播感染。主要的解释变量是粮食不安全，使用经过文化适应和验证的巴西粮食安全量表进行测量。在多变量逻辑回归模型中，饥饿引起的严重粮食不安全与过去 12 个月内一致性避孕套使用的几率降低（调整后的优势比 [AOR] = 0.67；95%CI，0.48-0.92）和最近一次性行为时使用避孕套（AOR = 0.75；95%CI，0.57-0.98）有关。自我报告的阴道瘙痒与所有粮食不安全类别有关（AOR 范围从 1.46 到 1.94）。就所有结果而言，效应大小在绝对值上都很大。在观察到的关联中，体重不足和/或对性关系缺乏控制似乎没有起到中介作用。
饥饿引起的严重粮食不安全与避孕套使用几率降低和阴道瘙痒几率增加有关，这可能表明有性传播感染，在巴西活跃的女性中。针对粮食不安全的干预措施可能对资源有限环境中的艾滋病毒预防产生有益影响。
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