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Community and International Nutrition

Food Insecurity and Hunger Are Prevalent among HIV-Positive Individuals in British Columbia, Canada¹

Lena Normén^*,2, Keith Chan, Paula Braitstein, Aranka Anema, Greg Bondy, Julio S. G. Montaner^*, and Robert S. Hogg^,**

^* Canadian HIV Trials Network, Pacific Region, St. Paul’s Hospital, Vancouver, British Columbia, Canada; British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada; and Departments of Pathology and Laboratory Medicine and ^** Health Care and Epidemiology, University of British Columbia, Vancouver, BC, Canada

²To whom correspondence should be addressed. E-mail: lnormen{at}providencehealth.bc.ca.

Hunger and food insecurity are important factors that may affect an individual’s nutritional state and should therefore be assessed in nutrition surveillance activities. The objective of this study was to determine the level of food insecurity and hunger among HIV-positive persons accessing antiretroviral therapy in British Columbia. A cross-sectional study was performed in the BC HIV/AIDS drug treatment program, a province-wide source of free-of-charge antiretroviral medications. In 1998–1999, participants completed a questionnaire focusing on personal information, health, and clinical status. Food and hunger issues were evaluated with the Radimer/Cornell questionnaire. Overall, 1213 responding men and women were classified as food secure (52%), food insecure without hunger (27%), or food insecure with hunger (21%). In both categories of food insecurity, individuals were significantly more likely to be women, aboriginals, living with children, and to have less education, a history of recreational injection drug and/or alcohol abuse, and an unstable housing situation (P < 0.05). In logistic multivariate modeling, income Can$10,000 [adjusted odds ratio (AOR) 3.78, 95% CI (2.53–5.65)], shared household with children [AOR 3.68, 95% CI (1.98–6.84)] and unemployment [AOR 3.15, 95% CI (1.94–5.13)] were the strongest predictors of hunger. In HIV-positive individuals, the occurrence of food insecurity was nearly 5 times higher than in the general Canadian population. The results should stimulate further research to identify to what extent hunger-associated factors are reversible with interventions built on nutritional and/or social strategies.

KEY WORDS: • food insecurity • hunger • human immunodeficiency virus • body mass index • antiretroviral therapy