Food insecurity and substance use in people with HIV infection and substance use disorder

Abstract

Background

Food insecurity and substance use are common among people living with HIV (PLWH). Substance use may help people cope with hunger and thus be associated with food insecurity, but the association is uncertain. This study assessed whether, in PLWH and substance dependence, if there was an association between food insecurity and substance use.

Methods: We studied adults with HIV and current substance dependence or ever injection drug use interviewed at 12 and 24 months after enrollment in a prospective cohort study. The presence of food insecurity (insufficient food quantity or quality, or anxiety about its availability) was assessed using the Household Food Insecurity Assessment Scale questionnaire (HFIAS). Unhealthy alcohol use was assessed with the Alcohol Use Disorder Identification Test – Consumption (AUDIT-C) and past 30-day other drug use with the Addiction Severity Index. Associations using repeat cross-sectional data from each of two time-points, 12 months apart, from the same participants were tested using generalized estimating equations logistic regressions.

Results: The 233 participants had a mean age of 50 years and 65% were male. At the first interview, 44% reported food insecurity, 40% unhealthy alcohol use, 25% past 30-day cocaine use, and 17% past 30-day illicit opioid use. In analyses adjusted for demographics, social factors, physical and mental health function, and substance use related variables, there was no significant association between food insecurity and unhealthy alcohol use (adjusted odds ratio (aOR) = 1.06 (95% CI: 0.59, 1.87)). Those with food insecurity had higher odds of illicit opioid use (aOR = 2.5 (95% CI: 1.12, 5.58)) and cocaine use (aOR = 1.95 (CI 95%: 1.00, 3.81)).

Conclusion: Food insecurity was not associated with unhealthy alcohol use but was associated with cocaine and illicit opioid use. Given the prevalence and impact substance use has on PLWH, food insecurity should be identified and addressed.

Keywords:

• Addiction
• food insecurity
• cocaine
• alcohol
• HIV
• people living with HIV
• PLWH
• AIDS
• opioids
• substance use disorder

Acknowledgements

This research was made possible by the Boston ARCH Cohort study participants, as well as the Boston University and Boston Medical Center staff who supported this research project. Akila Raja is currently a medical student at Philadelphia College of Osteopathic Medicine and Aldina Mesic is a PhD student at University of Washington. We would like to thank Meg Sullivan for contributing her time and clinical knowledge to this manuscript, as well as staff researchers for their contributions to patient recruitment. Finally, we would like to thank Seville Meli for her support in study management and organization.

Additional information

Funding

This study was funded through the National Institute of Alcohol Abuse and Alcoholism [U01AA020784, U24AA020779, and U24AA020778] and the National Center for Advancing Translational Science [UL1TR001430]. All data collection, analysis, or interpretation of data was done independently of the NIAAA. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.