HIV and nutritional status of women in sub-Saharan Africa: Implications for food security and treatment programs

Background

In the absence of antiretroviral therapy (ART), HIV-positive people will become wasted or severely underweight. But obesity levels are increasing in several sub-Saharan African countries with widespread HIV infection and little ART. HIV prevalence in several of these countries is higher among overweight people than those of normal or below-normal body weight. We therefore investigate the relationship of HIV with body mass index (BMI) and anemia as indicators of nutritional status.

Methods

Data come from 12 nationally-representative Demographic and Health Surveys conducted between 2003-2006 in Burkina Faso, Cameroon, Ethiopia, Ghana, Guinea, Kenya, Lesotho, Malawi, Niger, Rwanda, Senegal, and Zimbabwe. BMI and anemia data were consistently available only for adult women, limiting our focus. Descriptive and multivariate methods were used. Country data were pooled to the regional level when necessary.

Results

HIV prevalence is highest among overweight women in five of the twelve countries studied. HIV prevalence increases steadily as levels of anemia increase in all countries except Ethiopia. HIV is positively associated with BMI in unadjusted models, but is significantly negatively associated with BMI and hemoglobin levels (the latter used as a linear term in multivariate models) after controlling for background characteristics.

Conclusions

HIV infection is independently associated with poorer nutritional status of women. Increasing food security and nutritional supplementation to HIV-positive people could improve length and quality of life. At the same time, HIV prevalence is higher among women who are better off nutritionally, so treatment and care programs need to target both the under- and over-nourished. Ill effects of ART have been seen among both under- and over-weight patients. As rates of both obesity and malnutrition rise in developing countries, clinicians providing ART should consider patient's nutritional status and titrate drug combinations to patient's body weights when possible to limit adverse effects.