Food insecurity increases the risk of death among injection drug users living with HIV/AIDS even when they are receiving life-prolonging antiretroviral therapy (ART), according to a new study involving Simon Fraser University.
The study, recently published in the peer-reviewed science journal, PLoS One, examines the impact of food insecurity and hunger on survival among injection drug users. Food insecurity is defined by the United Nations' World Food Programme as having insufficient access to adequate quantity and quality of food. Researchers found that drug users who were food insecure when first initiating ART were twice as likely to die compared to individuals who were food secure.
"This is the first study to look at the impact of food insecurity on the survival of HIV-positive injection drug users," says senior author Robert Hogg, an SFU health sciences professor and director of the HIV/AIDS Drug Treatment Program at the BC Centre for Excellence in HIV/AIDS (BC-CfE).
Hogg is responsible for the B.C. portion of a national HIV food security study, which this paper advances.
"The introduction of life-saving antiretroviral therapy has significantly reduced HIV-related morbidity and mortality, however, the impact of insufficient access to food, particularly quality food, on the mortality of HIV-positive injection drug users is alarming. This research points to the urgent need to further investigate the impact of food insecurity on the health outcomes of people living with HIV/AIDS."
Researchers followed 254 injection drug users across B.C., finding that 71 per cent of them reported being food insecure at the time of ART initiation. After 13 years of follow-up, drug users who were food insecure were twice as likely to die compared to individuals who were food secure. Sub-analyses found hunger, or food insufficiency, was not the primary cause of mortality in this population.
"Findings regarding the relationship between food insecurity and mortality are particularly relevant to community organizations working in Vancouver's Downtown Eastside, the epicentre of drug use in Canada," says Brian Chittock. He is a co-principal investigator on the national HIV food security study and executive director of AIDS Vancouver.
"The findings speak to the need to explore options for improving the quality of foods available to residents. Further, the results suggest drug users would benefit from improved access to education and counseling around healthy eating, nutritional screening and referral for appropriate clinical care."
"Our work has international implications as it highlights the importance of food security for the sustained survival of HIV-positive people not just here in B.C., but in other parts of the world," says Aranka Anema. She is the first author on this study and a BC-CfE epidemiologist.
"We are collaborating with the United Nations World Food Program and other international agencies to identify evidence-based practices and policies for the prevention and management of food insecurity among people living with HIV/AIDS."
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