Exploring Food Insecurity in HIV-Positive Inpatients at Grady Memorial Hospital in Atlanta, GA Open Access
Hurlston, Mackenzie Ann (2012)
Abstract
Background
Limited research has shown food insecurity or the "limited or
uncertain availability of nutritionally adequate and safe foods" to
be a barrier to optimal HIV related health outcomes.
Objective
To describe the prevalence and correlates of
food insecurity in HIV-positive inpatients at Grady Memorial
Hospital in Atlanta, GA. as well as to explore the competing
demands between food insecurity, drug use, and access to treatment
and care.
Methods
Structured interviews were administered at the
bedside to participants recruited from inpatient medicine wards for
a one time cross-sectional survey. The Household Food Insecurity
Access Scale (HFIAS) questionnaire was used to assess food
insecurity.
Results
Among 63 participants, 71.4% were food insecure and 44.4% were
severely food insecure. In bivariate analysis food insecurity was
significantly associated with ever and current homelessness, lack
of health insurance, and monthly income less than $600. In adjusted
analysis, food insecurity was marginally significantly associated
with ever homeless (AOR 3.37, CI=0.86-13.2). Monthly income greater
than $600 neared a protective effect against
food insecurity (AOR 0.32, CI=0.08-1.23). Twenty percent of food
insecure patients reported missing a healthcare appointment in the
past 90 days because they needed to spend money on food and 18%
reported the reverse: skipping a meal to pay to get to medical
appointment.
Conclusions
The prevalence of food insecurity seen in
HIV-positive inpatients at Grady Memorial Hospital is the largest
reported prevalence among people living with HIV/AIDS in the United
States, a majority whom reported experiencing severe food
insecurity. Competing demands seen between food and medical
treatment among the food insecure participants suggests that food
insecurity is directly affecting access to medical care. Finally
limited food stamp data suggest a significant underutilization of
national food services in this population. More research,
specifically longitudinal studies, are necessary given the high
prevalence of food insecurity in this population in order to fully
understand how food insecurity affects treatment and care of HIV
positive individuals at Grady Memorial Hospital.
Table of Contents
Table of Contents
1 Introduction...1
2 Literature Review...5
2.1 Introduction to the Literature
Review...5
2.2 Measuring Food Insecurity...5
2.3 Establishing Food Insecurity Prevalence in PLWHA...7
2.4 Sociodemographic and Behavioral Correlates of Food Insecurity
in PLWHA...9
2.5 Clinical Outcomes Associated with Food insecurity in
PLWHA...13
2.6 Conclusions...15
3 Methodology...16
3.1 Objectives...16
3.2 Participants and Setting...16
3.3 Ethics...17
3.4 Data Collection...17
3.5 Food Insecurity Assessment...17
3.6 Analysis...19
4 Results...21
4.1 Participant Characteristics...21
4.2 Characterization of Food Insecurity...23
4.3 Correlates of Food Insecurity...24
4.4 Competing Demands...26
5 Discussion...30
5.1 Main Findings...30
5.2 Strengths and Limitations...38
5.3 Public Health Implications...39
References
Appendix I: HFIAS questionnaire
Appendix II: HFIAS category formulas
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