Food insecurity and alcohol use in people with HIV infection and substance use disorder
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BACKGROUND: Food insecurity and alcohol consumption are prevalent and have health consequences among people living with HIV infection or AIDS (PLWHA). Food insecurity could be associated with unhealthy alcohol use via hunger or other mechanisms. However, it is not well-known whether the two (food insecurity and unhealthy alcohol use) are associated. OBJECTIVE: The objective of this study was to determine an association between food insecurity and unhealthy alcohol use in people with HIV/AIDS and substance use disorder. It was hypothesized that food insecurity, compared to food security, would be associated with unhealthy alcohol use in this population. METHODS: This study is a cross sectional analysis of data collected from adults with HIV infection and current alcohol or other drug dependence or ever injection drug use, who were participants in a cohort study known as the Boston Alcohol Research Collaboration on HIV/AIDS (ARCH) study. Food insecurity, the independent variable, was assessed using the Household Food Insecurity Assessment Scale (HFIAS) questionnaire (defined as a dichotomized measure of food insecure (mild, moderate, severe) versus food secure). Unhealthy alcohol use, the dependent variable, was assessed using the Alcohol Use Disorder Identification Test – Consumption (AUDIT-C) questionnaire (defined as a score greater than 3 in males and a score greater than 2 in females). Participants were assessed at two time points 12 months apart. In generalized estimating equations, we studied the association between food insecurity and unhealthy alcohol use at each time point. Covariates adjusted for included age, sex, race, HIV viral load, CD4 cell count, physical health, mental health, number of people the individual spent time with who were heavy or problem drinkers, homelessness, if the participant had someone to turn to in a time of need, and drug dependence. RESULTS: Of the 250 participants enrolled in the Boston ARCH cohort, 233 completed the HFIAS and the AUDIT-C questionnaires at either or both time points. There were 100 participants who completed the questionnaires at time point 1 only, 67 at time point 2 only, and 66 at both time points resulting in a total of 299 data points. The mean age of our sample was in the 6th decade and the majority were Black/African American and identified as male. The majority (80%) had an HIV viral load under 200 and over half of the sample also had a CD4 cell count greater than or equal to 500. Unhealthy alcohol use was common (40%) and 44% had food insecurity. In unadjusted analysis, food insecurity was associated (p=0.08) with unhealthy alcohol use [OR=1.58 (CI 95%: 0.95, 2.62)]; however, this association disappeared in adjusted analysis [OR: 1.06 (CI 95%: 0.59, 1.87), p=0.85].