Food Insecurity and HIV

May 2019 Council

Lead Division/Office

ONR / DDN

Point(s) of Contact

Peter Perrin, Ph.D.

Executive Summary

Food insecurity is the lack of consistent access to enough food for an active healthy life. The USDA’s Economic Research Service estimates that 11.8 percent of American households were food insecure at some time in 2017 with a prevalence of very low food insecurity (multiple incidents of disrupted eating patterns and reduced food intake) of 4.5 percent. Food insecurity intersects with other social determinants of health, and has a significant impact on health behaviors such as adherence to medication regimens and health outcomes.

Long term antiretroviral therapy (ART) reduces viral load, significantly improving the health and quality of life of people with HIV (PWH). PWH who adhere to their ART treatment plan, and maintain viral suppression, have an improved quality of life, reduced morbidity and mortality, and are more likely to adhere to treatment plans for comorbidities, coinfections, and complications, In addition, viral suppression to undetectable levels prevents virus transmission (“undetectable = untransmittable”).

Non-adherence to ART treatment plans results in increased viral load and chance of transmission, progression to AIDS, and increased mortality. Food insecurity is a complex problem that intersects with other social determinants of health. PWH with food insecurity face multiple challenges to ART adherence and to staying in care for comborbidities, coinfections, and disease complications, so they have poorer outcomes. Likewise, food insecure people at risk for HIV are less likely to avail themselves of HIV screening or adhere to pre-exposure prophylaxis (PrEP). The President’s initiative, Ending the HIV Epidemic: A Plan for America (EtHE), has the bold goal of reducing new HIV infections in the United States by 75% in 5 years and at least 90% in 10 years. The success of EtHE is critically tied to overcoming barriers to treatment initiation and adherence, including food insecurity, in the communities affected by the epidemic.