Food insecurity, intimate partner violence, and HIV risk: Population-based study of linked couples in Nepal

Background: Food insecurity has recently emerged as an important risk factor for HIV acquisition risk among women worldwide. A few studies have examined this this relationship among men, but none have had access to linked data that would permit study of the differential effects of food insecurity on HIV risk among men and women in the same households. We sought to examine the food insecurity-HIV risk relationship using nationally representative data on linked couples in Nepal, a resource-limited setting where both food insecurity and violence against women are common.

Methods: We used nationally representative data on linked married or cohabiting couples from the Nepal 2011 Demographic and Health Survey. Outcomes were: (a) condom use at last sexual intercourse, (b) consistent condom use with the most recent sexual partner, (c) self-reported genital discharge, (d) self-reported genital sore or ulcer; and, among women only, (e) experience of violence by the spouse or partner. The primary explanatory variable of interest was food insecurity, measured with the Household Food Insecurity Access Scale. Multivariable logistic regression models employed variance estimates that accounted for the complex survey design.

Results: Both food insecurity and partner violence were highly prevalent. Food insecure women were more likely to report having been victimized, less likely to report recent condom use, and more likely to report symptoms consistent with sexually transmitted infection. These patterns were absent among men.

Conclusions: Interventions targeting food insecurity may have beneficial implications for both HIV prevention and gender equity in Nepal.