Food Insecurity Tied to Stigma and Depression in U.S. Women Living With HIV

Analysis of 1,238 HIV-positive U.S. women found associations between food insecurity (limited access to nutritional food) and both depressive symptoms and internalized HIV stigma. Women's Interagency HIV Study (WIHS) investigators suggested that "[a]ddressing food insecurity may improve psychosocial outcomes among women with HIV." The study results were presented in an AIDS 2016 poster.

WIHS investigators noted that research independently links food insecurity, internalized stigma and depressive symptoms to poor HIV outcomes. But the relationship between food insecurity and stigma or depressive symptoms remains poorly understood. To address these issues, the WIHS team analyzed 2013 cross-sectional data on 1238 WIHS participants with HIV. They assessed food insecurity, internalized stigma and depressive symptoms with validated scales, then tested associations between food insecurity and psychosocial outcomes with recursive structural equation models adjusting for demographic, socioeconomic and clinical variables of interest.

The researchers determined that 41.6% of women had food insecurity, that is, marginal, low or very low versus high food security. Women's depressive symptom scores averaged 12.3 on a scale of 0 to 60, and 32.6% of women screened positive for probable depression. The internalized stigma score averaged 1.76 on a scale of 1 to 4, with 4 indicating the highest stigma level.

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The adjusted models determined that worse food insecurity meant worse internalized stigma and depressive symptoms. Internalized stigma scores were 0.105 higher with marginal food security (versus high food security), 0.215 higher with low food security and 0.486 higher with very low food security (P < .05 for all). Depressive symptom severity scores were 3.50 higher with marginal food security, 4.49 higher with low food security and 7.27 higher with very low food security (P < .05 for all).

An analysis that accounted for potential confounders (age, race/ethnicity, income, educational level, child dependents, nadir CD4 count and illicit drug use) determined that food insecurity accounted for 20% of the total proportion of variance in depressive symptoms explained by internalized stigma -- and vice versa.

WIHS investigators concluded that food insecurity is associated with both depressive symptoms and internalized HIV stigma in U.S. women with HIV. They suggested that "[f]ood insecurity may play an important role in the negative cycle between depression and internalized stigma." And they called for longitudinal studies to delineate causal ties between food insecurity, stigma and depression.