Exploring Food Insecurity in HIV-Positive Inpatients at Grady Memorial Hospital in Atlanta, GA Open Access

Hurlston, Mackenzie Ann (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/7m01bk791?locale=en%255D
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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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