Food Insecurity Tied to HIV, Other STIs and Drug Use in U.S. Men

A limited ability to access nutritious food independently predicted prevalent HIV infection, other sexually transmitted infections (STIs) and illicit drug use in a nationally representative sample of men in the U.S. general population, according to a recent study. These associations generally held true in analyses restricted to lower-income men.

Previous research tied food insecurity to higher rates of HIV risk behaviors, including risky sex and substance use. But the impact of food insecurity on prevalent HIV and other STIs in U.S. men had not been determined until this study by a multicenter U.S. team. Men account for approximately 80% of new HIV diagnoses in the U.S.

In a study published in the June 1 issue of AIDS, researchers used 1999-2012 data from the National Health and Nutrition Examination Survey (NHANES), which yields nationally representative estimates of the U.S. general population. NHANES participants are interviewed and examined, and they give samples to determine HIV and herpes simplex virus-2 (HSV-2) serostatus. The research team compared prevalence of four outcomes (HIV, HSV-2, other self-reported STIs and illicit drug use in the past year) in food-insecure and food-secure men in analyses controlling for confounders including age, poverty-income ratio, high school education and race/ethnicity.

The study sample consisted of 9150 men 20 to 49 years old representing 61 million men in the U.S. general population. HIV prevalence measured 0.65% and HSV-2 prevalence 13.0%. Almost 5% of men reported another STI and 6.8% reported using cocaine, heroin or methamphetamine in the past year. Almost one-quarter of men, 22.3%, lived in a food-insecure household. Compared with food-secure men, food-insecure men had higher prevalence of HIV (1.5% versus 0.4%, P < .001), HSV-2 (17.4% versus 11.9%, P < .001), other STIs (5.5% versus 4.8%, P = .289) and illicit drug use in the past year (11.4% versus 5.4%, P < .001).

Statistical analysis adjusted for demographic, socioeconomic and behavioral factors determined that food insecurity doubled the odds of HIV positivity (adjusted odds ratio [aOR] 2.10, 95% confidence interval [CI] 1.01 to 4.37, P < .05) and independently raised the odds of HSV-2 positivity (aOR 1.28, 95% CI 1.04 to 1.57, P < .05), other STIs (aOR 1.54, 95% CI 1.08 to 2.20, P < .05) and illicit drug use (aOR 1.57, 95% CI 1.14 to 2.15, P < .01). Sensitivity analyses limited to men with lower income (such as 100%, 200% and 400% of the federal poverty level) yielded similar results.

In analyses limited to men who have sex with men (MSM), food-insecure men had significantly higher rates of HIV infection (14.1% versus 5.9%, P < .05) and HSV-2 infection (30.5% versus 17.2%, P < .05) and nonsignificantly higher rates of self-reported STIs (15.7% versus 9.2%, P = .127) and illicit drug use (14.6% versus 10.5%, P = .383). Adjusted analyses found nonsignificantly higher odds of these outcomes in food-insecure MSM.

The researchers believe the sensitivity analyses in the overall study population indicate that "food insecurity is not simply a proxy for poverty." They propose that the association between food insecurity and HIV "may be bidirectional": While poor nutrition may heighten chances of HIV acquisition, HIV infection "may also constitute an economic shock in individuals' lives . . . that could lead to food insecurity." They conclude that "the strong associations between food insecurity, HIV risk factors, and HIV serostatus in this study, independent of [socioeconomic status], suggest that food insecurity may be an important factor in the national HIV epidemic and should be addressed." Nevertheless, longitudinal studies are needed to support that hypothesis.