Online Program

Impact of food insecurity on survival among HIV-positive injection drug users receiving antiretroviral therapy in a Canadian cohort

Tuesday, November 5, 2013 : 1:30 p.m. - 1:45 p.m.

Aranka Anema, Dr., Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Keith Chan, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
Yalin Chen, Drug Treatment Programe, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
Sheri Weiser, MD, MPH, Division of HIV/AIDS, Department of Medicine, University of California at San Francisco, San Francisco, CA
Julio Montaner, Dr., Department of AIDS, Division of AIDS, University of British Columbia, Vancouver, BC, Canada
Robert Hogg, Dr., Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
Background: Little is known about the potential impact of food insecurity on mortality among people living with HIV/AIDS. We examined the potential relationship between food insecurity and all-cause mortality among HIV-positive injection drug users (IDU) initiating antiretroviral therapy (ART) across British Columbia (BC). Methods: Cross-sectional measurement of food security status was taken at time participant ART initiation. Participants were prospectively followed from June 1998 to September 2011 within the fully subsidized ART program. Cox proportional hazard models were used to ascertain the association between food insecurity and mortality, controlling for potential confounders. Results: Among 254 IDU, 181 (71.3%) were food insecure and 108 (42.5%) were hungry. After 13.3 years of median follow-up, 105 (41.3%) participants died. In multivariate analyses, food insecurity remained significantly associated with mortality (adjusted hazard ratio [AHR]=1.95, 95% CI: 1.07–3.53), after adjusting for potential confounders. Conclusions: HIV-positive IDU reporting food insecurity were almost twice as likely to die, compared to food secure IDU. Further research is required to understand how and why food insecurity is associated with excess mortality in this population. Public health organizations should evaluate the possible role of food supplementation and socio-structural supports for IDU within harm reduction and HIV treatment programs.

Learning Areas:

Administer health education strategies, interventions and programs
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Define food insecurity; Discuss prevalence and correlates of food insecurity among illicit drug users; Describe potential mechanisms linking food insecurity to adverse HIV clinical outcomes; Explain relationship between food insecurity and mortality; Formulate further research questions; Discuss potential public health implications

Keyword(s): Drug Injectors, Food Security

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I held a federal doctoral trainee award on the topic of food insecurity, drug use and HIV/AIDS. I am a co-investigators on several federally funded grants focusing on social determinants of health and HIV. I have published extensively on the topic of food insecurity and am a designated Academic Focal Point for a United Nations Inter-Agency Task Team on HIV, Nutrition and Food Insecurity.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.