International AIDS Society

Food Insecurity Tied to HIV Risks in National Study of Brazilian Women

Author: Mark Mascolini

18 April 2012

Severe food insecurity with hunger independently lowered chances of consistent condom use, according to results of a national 12,684-woman survey in Brazil. Any level of food insecurity raised the risk of itchy vaginal discharge, which may indicate sexually transmitted infection (STI).

Food insecurity—difficulty in getting a steady supply of nutritious food—may have multiple impacts on the clinical and sociologic welfare of any population. “This is particularly the case in Brazil,” these researchers maintain, “which has undergone successive changes in the gender and socio-geographic composition of its complex [HIV] epidemic over the past three decades.”

To assess the impact of food insecurity on risky sexual behavior, these investigators used data on 12,684 sexually active women collected in a 2006-2007 national Brazilian survey. They focused on how food insecurity affects three self-reported outcomes:

— Consistent condom use, defined as always using a condom during sexual intercourse in the previous 12 months

— Recent condom use, defined as using a condom with the most recent sex partner

— Itchy vaginal discharge in the previous 30 days, possibly indicating STI

The researchers assessed food insecurity with the Escala Brasiliera de Segurança Alimentar, an 18-item culturally adapted and validated questionnaire that asks about the quantity and quality of food available to people over the previous 3 months.

Among women with severe food insecurity and hunger—the most extreme category of food insecurity assessed—10.5% reported consistent condom use, compared with 15% of women without food insecurity. Notably, consistent condom use was rare throughout this population.

Multivariable logistic regression analysis determined that severe food insecurity with hunger made consistent condom use 33% less likely (adjusted odds ratio [AOR] 0.67, 95% confidence interval 0.48 to 0.92). This worst category of food insecurity made condom use during the last sex act 25% less likely (AOR 0.75, 95% CI 0.57 to 0.98).

All categories of food insecurity raised the odds of self-reported itchy vaginal discharge, with adjusted odds ratios ranging from 1.46 to 1.94.

Being underweight or reporting lack of control in sexual relations did not appear to affect condom use or itchy vaginal discharge.

Commenting on this study, the editors of PLoS Medicine observe that the findings do not mean food insecurity causes risky sex, and they caution that the results may not apply to other populations. Also, the editors note that the researchers did not distinguish between condom use with regular partners and casual partners.

With these caveats in mind, the editors believe “these findings suggest that interventions that target sexual risk reduction behaviors are unlikely to be optimally effective if food insecurity is not taken into account.”

Source: Alexander C. Tsai, Kristin J. Hung, Sheri D. Weiser. Is food insecurity associated with HIV risk? Cross-sectional evidence from sexually active women in Brazil. PLoS Medicine. 2012; 9(4): e1001203.

Complete article provided by PLoS Medicine, an open-access journal