Whittle Henry J, Palar Kartika, Seligman Hilary K, Napoles Tessa, Frongillo Edward A, Weiser Sheri D
Global Health Sciences, University of California, San Francisco (UCSF), Mission Hall/Global Health and Clinical Sciences Building, 550 16th Street, 3rd Floor, San Francisco, CA 94158-2549, United States.
Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, United States.
Soc Sci Med. 2016 Dec;170:228-236. doi: 10.1016/j.socscimed.2016.09.040. Epub 2016 Oct 19.
Food-insecure people living with HIV/AIDS (PLHIV) consistently exhibit worse clinical outcomes than their food-secure counterparts. This relationship is mediated in part through non-adherence to antiretroviral therapy (ART), sub-optimal engagement in HIV care, and poor mental health. An in-depth understanding of how these pathways operate in resource-rich settings, however, remains elusive.
We aimed to understand the relationship between food insecurity and HIV health among low-income individuals in the San Francisco Bay Area using qualitative methods.
Semi-structured in-depth interviews were conducted with 34 low-income PLHIV receiving food assistance from a non-profit organization. Interviews explored experiences with food insecurity and its perceived effects on HIV-related health, mental health, and health behaviors including taking ART and attending clinics. Thematic content analysis of transcripts followed an integrative inductive-deductive approach.
Food insecurity was reported to contribute to poor ART adherence and missing scheduled clinic visits through various mechanisms, including exacerbated ART side effects in the absence of food, physical feelings of hunger and fatigue, and HIV stigma at public free-meal sites. Food insecurity led to depressive symptoms among participants by producing physical feelings of hunger, aggravating pre-existing struggles with depression, and nurturing a chronic self-perception of social failure. Participants further explained how food insecurity, depression, and ART non-adherence could reinforce each other in complex interactions.
Our study demonstrates how food insecurity detrimentally shapes HIV health behavior and outcomes through complex and interacting mechanisms, acting via multiple socio-ecological levels of influence in this setting. The findings emphasize the need for broad, multisectoral approaches to tackling food insecurity among urban poor PLHIV in the United States.
与粮食安全的艾滋病毒/艾滋病感染者相比，粮食不安全的艾滋病毒/艾滋病感染者（PLHIV）的临床结局一直较差。这种关系部分是通过对抗逆转录病毒疗法（ART）的不依从、对艾滋病毒护理的参与度欠佳以及心理健康状况不佳来介导的。然而，对这些途径在资源丰富环境中的运作方式的深入理解仍然难以捉摸。
我们旨在使用定性方法了解旧金山湾区低收入人群中粮食不安全与艾滋病毒健康之间的关系。
对34名从非营利组织获得粮食援助的低收入PLHIV进行了半结构化深度访谈。访谈探讨了粮食不安全的经历及其对艾滋病毒相关健康、心理健康和健康行为（包括服用抗逆转录病毒药物和就诊）的感知影响。对访谈记录进行主题内容分析采用了归纳-演绎综合方法。
据报告，粮食不安全通过多种机制导致抗逆转录病毒疗法依从性差和错过预定的诊所就诊，包括在没有食物的情况下抗逆转录病毒疗法副作用加剧、饥饿和疲劳的身体感受以及公共免费就餐场所的艾滋病毒污名化。粮食不安全通过产生饥饿的身体感受、加剧先前存在的抑郁挣扎以及培养对社会失败的长期自我认知，导致参与者出现抑郁症状。参与者进一步解释了粮食不安全、抑郁和抗逆转录病毒疗法不依从如何在复杂的相互作用中相互强化。
我们的研究表明，粮食不安全如何通过复杂且相互作用的机制对艾滋病毒健康行为和结局产生不利影响，在这种情况下通过多个社会生态影响层面发挥作用。研究结果强调需要采取广泛的多部门方法来解决美国城市贫困PLHIV中的粮食不安全问题。
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