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).
Documenting high levels of food insecurity and overweight among people with HIV in Latin America and the Caribbean and highlighting food gaps have important implications for interventions, since prior efforts to address food insecurity among people with HIV have focused on underweight and wasting.
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
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.
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.
PLHIV who experience food insecurity face various barriers to engaging in healthy dietary behaviours. Their diets are influenced at multiple levels of influence ranging from individual to structural, requiring multi-level interventions that can address these factors concurrently.
A qualitative approach was used to explore the impact of an HIV diagnosis on women in the Dominican Republic and coping strategies after diagnosis. We conducted in-depth, semistructured interviews with a purposive sample of women living with HIV.
Economic instability is the key driver of food insecurity among women living with HIV in the Dominican Republic.
We found severe food insecurity associated with increased BMI and body fat as well as higher odds of being overweight among PLHIV in the DR.
This study examines nutrition and food insecurity among antiretroviral therapy patients in Honduras.
Optimal strategies to improve food security and nutrition for people living with HIV (PLHIV) may differ in settings where overweight and obesity are prevalent and cardiovascular disease risk is a concern.
Food insecurity and malnutrition negatively affect adherence to antiretroviral therapy (ART) and are associated with poor HIV clinical outcomes.
Health and development organizations increasingly promote livelihood interventions to improve health and economic outcomes for people living with HIV (PLHIV) receiving treatment with antiretroviral therapy (ART).
Provides an overview of the HIV/AIDS epidemic in Belize, Guatemala, and Honduras, describes the role that faith-based organizations play in addressing HIV in these countries, and discusses how this role might be expanded.