How Food Insecurity Affects People Living with HIV in Latin America and the Caribbean

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Food insecurity means not being sure that nutritional, safe foods will be available, or not being able to get food in socially acceptable ways.

RAND research has identified food insecurity as a barrier to adhering to antiretroviral therapy (ART) for HIV. Poor adherence to ART is a serious public health problem. Good adherence not only dramatically improves health for people with HIV, it also reduces the amount of HIV in an individual’s blood; as a result, the virus cannot be transmitted. Given this link, treatment essentially becomes prevention, and adherence is the key.

To address the challenges of food insecurity, RAND researcher Kathryn Derose and her team developed a decade-long partnership between RAND and the World Food Programme and local partners across various countries to develop and evaluate pilot projects that address food insecurity and nutritional needs of people with HIV in Latin America (Bolivia, Honduras, and the Dominican Republic).

Background

Most previous work on food insecurity among people with HIV focused on undernutrition and providing food. In Latin America and Caribbean, RAND researchers found that overweight and obesity were the most common forms of malnutrition among people with HIV and often co-existed with food insecurity. In exploratory work across all three countries, the RAND team discovered that healthcare providers caring for individuals living with HIV knew little about their patients’ nutritional needs, and there were few nutritionists and nutritional training programs. This knowledge gap made nutritional counseling for individuals who were obese, overweight, or underweight a priority across all three sites. But given the high levels of food insecurity, it was also important to pair nutritional counseling with strategies that provided access to nutritious foods.

RAND researchers found that overweight and obesity were the most common forms of malnutrition among people with HIV and often co-existed with food insecurity.

RAND’s research evolved to address these needs:

  • Because of the consistently high levels of food insecurity among people with HIV across the various countries, the team focused initially on providing food (Honduras, Bolivia) paired with nutritional counseling.
  • Nutritional counseling alone improved food security and helped people who were underweight gain weight; those who were overweight lost weight, and improved their adherence to ART. Food baskets improved food security even more over the short term but were not sustainable and increased weight among those already overweight.
  • Transferring the nutritional counseling from professional nutritionists to peer counselors was feasible and improved food security, nutritional knowledge, and dietary diversity.
  • A more sustainable strategy – pairing peer nutritional counseling with urban gardens – became the subsequent focus. It is currently being tested to examine how this approach affects viral load, adherence to ART, and other health-related outcomes among people with HIV in the Dominican Republic.

Across all phases of these studies, RAND partnered not only with the World Food Programme, but also with local stakeholders in each country, including governmental agencies, associations of people with HIV, and HIV clinics.

Learn More About the Studies

  • A farmer receives a bag of provisions, donated by the United Nations World Food Programme, during a distribution of aid to families affected by the drought in the village of Orocuina, Honduras, August 28, 2014, photo by Jorge Cabrera/Reuters

    Food Baskets and Nutritional Counseling in Honduras and Bolivia

    RAND’s work in Honduras and Bolivia grappled with the challenge of improving adherence to antiretroviral therapy (ART) among individuals for whom food insecurity was a constant source of anxiety and poor nutrition.

  • Moving to More Sustainable Strategies in the Dominican Republic

    Working with local collaborators and stakeholders, RAND identified urban gardens as a possible way to support food security in a sustainable way. This pilot study integrates urban gardens and peer nutritional counseling to examine effects on adherence, viral load, and other important outcomes.