Food insecurity is associated with HIV serostatus among low income adults in the national health and nutrition examination survey (NHANES) (1999-2008)

Background: Food insecurity is associated with risky sexual practices and sexual violence in multiple studies, suggesting a link to HIV acquisition. Yet no population-based studies have examined the association between food insecurity and HIV serostatus. Methods: We conducted a cross-sectional analysis of the nationally representative, population-based National Health and Nutrition Examination Survey (NHANES) (1999-2008). We included participants ages 18 to 49 with incomes under 300% of the federal poverty line. The primary outcome, HIV serostatus, was assessed via blood test conducted during the NHANES examination. Household food security was measured using a validated scale developed by the US Department of Agriculture and individuals were dichotomized as having low or very low food security (“severe food insecurity”) versus all other categories. Analyses were adjusted for sex, age, race, marital status, household size, income, and education, and utilized appropriate design weights and complex survey commands. Results: We analyzed data for 8,991 participants, representing approximately 63 million non-institutionalized individuals in the US. HIV prevalence was 1.28% among those with severe food insecurity compared to 0.50% among those with full or marginal food security (p<0.01). Severe food insecurity was associated with over 2 times increased odds of HIV seropositivity [AOR = 2.42; 95% CI 1.06 - 5.57] in adjusted analyses. Conclusions: Household food insecurity is associated with HIV serostatus among low-income Americans. Improving access to food and participation in safety net programs may play a role in reducing HIV risk, but further research is needed to establish the causal relationship and direction.