Food Insecurity

What is Food Insecurity?

Food security is defined by the WHO as, “when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life” (World Health Organization). An individual/household is considered to be food secure if food is:

  • Available (food is produced or sold within a reasonable distance)
  • Accessible (food is affordable and physically present)
  • Stable (food access is not affected by seasonal disturbances or warfare)
  • Usable (food is safe and will not cause harm to the consumer)
Food Security

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When food is not available, accessible, stable, and usable an individual/household is considered food insecure. Many researchers believe that food insecurity stems from inadequate distribution of food resources, not a result of a world food shortage. Other researchers believe that there is not an adequate world supply of nutritious food, which may lead to a future increase in global food insecurity.

The Thomas Reuters Foundation provides a succinct video explanation of food insecurity: Food Insecurity Video.

Why is Food Insecurity important?

Food insecurity can lead to malnutrition and future health problems, including pre-mature death. Food insecurity is particularly important for younger generations. Childhood malnutrition can lead to frequent illness, growth impairments, and developmental impairments. This can impact a child’s ability to excel in school and later in the work force. Food insecurity can also have a large economic impact on a society. Hunger leads to a loss of productivity in the workforce, an increase in health care costs, and an increase in the cost of federal food programs (only in countries that have federal food programs). Food insecurity has far reaching impacts and deserves proper attention to reduce its prevalence world wide.

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Around the Globe:

  • According to the FAO (Food and Agriculture Organization of the United Nations) 842 million people were food insecure from 2011-2013.
  • 12% of the globe is food insecure.
  • The majority of food insecurity exists in developing countries.
    • Approximately 167 million people in Eastern Asia are food insecure.
    • 223 million people  in Sub-Saharan Africa are food insecure.
    • 295 million in Southern Asia are food insecure (FAO, IFAD, and WFP 2013).

Although, food insecurity tends to be concentrated in resource poor countries, food insecurity also exists in developed nations, such as the United States.

In the United States:

  • According to the USDA’s Economic Research Service 17.6 million households (14.5% of American households) were food insecure in the United States in 2012.
  • 49 million Americans were food insecure.
  • 67.6% of these individuals were adults.
  • 32.4% were children (Coleman-Jensen 2013).
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Why is Food Insecurity Important in HIV/AIDS?

Research has shown that food insecurity, nutrition and HIV/AIDS are intrinsically related.  A 2011 study found that 24% of the HIV cohort studied were identified as food insecure (Wang 2011). Food insecurity can lead to the spread of HIV/AIDS (through coping mechanisms, such as prostitution as a means to pay for food). Food insecurity, which can cause malnutrition, can also negatively impact HIV treatment and recovery. While HIV/AIDS can also lead to food insecurity. As researchers, it is important to recognize and take into consideration the complex relationship between food insecurity and HIV when conducting HIV research (especially in resource poor countries).

Food Insecurity Impacts HIV/AIDS:

Food insecurity has been shown to have a negative impact on HIV/AIDS treatment . Food insecurity’s influence on HIV/AIDS is multifaceted.

  • Weight loss: Food insecurity can lead to weight loss. When HIV patients lose weight, their likelihood for survival is significantly reduced.
    • Example: In a study on, “Weight loss and survival in HIV-positive patients in the era of highly active antiretroviral therapy,” researchers found that patients who lost 10% or greater of their body weight were “significantly associated with a four- to sixfold increase in mortality.” Patients who lost 3-5% of their body weight were also associated with an increase in mortality (Tang 2002). 
  • Overweight/Obesity: Food insecurity can lead to unintentional weight gain because affordable foods often tend to be more calorically dense and have poor dietary quality.
    • Example: A study of an HIV cohort in Navy HIV clinics found that 63% of their HIV patients were overweight/obese (Crum-Cianflone 2009).
  • Immune System: HIV patients already have a compromised immune system due to the presence of the human immunodeficiency virus. A nutritious and plentiful diet boosts the immune system. Without a nutritious diet, the immune system can be further compromised, which may allow opportunistic infections to take hold in the body.
    • Example: In a study on, “Food Insecurity is Associated with Incomplete HIV RNA Suppression Among Homeless and Marginally Housed HIV-infected Individuals in San Francisco,” researchers found that food insecurity was associated with 77% “lower odds of viral suppression.” Individuals with less then 80% medication adherence had 85% “lower odds of viral suppression.” (Weiser 2008).
  • Medication: A nutritious diet allows HIV medicine, like anti-retroviral therapy (ART), to function properly and can enhance its effect. Without proper nutritional intake, medicines may not function to their full potential and the impact of HIV treatment may be reduced.
    • Example: Patton et al. 2006 study showed that patients who have inadequate nutrition when they start ART’s are 6 times more likely to die then patients with adequate nutrition (Patton et al 2006).
  • Childhood Developmental Impairment: Children with HIV tend to suffer from more developmental impairment (including growth and mental impairment) then HIV-negative children of the same age. Food insecurity can worsen these statistics and lead to further growth impairments.
    • Example: Children with HIV tend to weigh 15 pounds lighter and be 3 inches shorter than children without HIV (Newell 2003).
  • Mental Health and Depression: HIV-positive patients tend to have more mental impairments then the general population. Food insecurity can worsen a mental health by causing anxiety about food acquisition and reducing nutrient intake that fuels the brain. Mental health problems can also lead to food insecurity among HIV-positive patients.
    • Example: In a study on “Food Insecurity Among Homeless and Marginally Housed Individuals Living with HIV/AIDS in San Francisco,” patients with depression were found to be two times more likely to be food insecure. Patients who were scored as mentally and physically healthy were 30% less likely to be food insecure (Weiser 2009).

HIV/AIDS Impacts Food Insecurity: 

Working to provide for a family becomes increasingly difficult for HIV/AIDS patients due to reduced faculties. When parents cannot work to their full potential they cannot make as much money for food. If they farm, they cannot grow and harvest as much food for their family. This can make their household more food insecure and perpetuate the debilitating cycle of HIV and food insecurity.

HIV/AIDS patients also require a higher energy intake then non-HIV patients. HIV positive adults require 10-30% more energy and children require 50-100% more energy intake (World Food Program 2008). Patients may have been able to access enough food prior to the acquisition of HIV, but with more food required to sustain a normal weight, HIV may lead patients to become food insecure.

Food Insecurity in HIV Research:

Food insecurity has recently been recognized as a contributing factor in the success of HIV/AIDS programs worldwide. In fact, the Office of the Global AIDS Coordinator (OGAC) in the US Congress, recently directed $100 million towards funding programs to reduce food insecurity in HIV/AIDS populations (Aberman 2014). Food insecurity has become an important topic in many types of HIV research:

  • Measures of food insecurity can be used to evaluate the future success of HIV treatment programs.
  • Measures of food insecurity may also be used to understand the reason for HIV transmission.
  • Further research is still necessary to better understand the relationship between HIV and food insecurity.

How do you measure Food Insecurity?

Food insecurity is typically measured by a Food Insecurity Survey.

Examples of Surveys:

  • Household Food Insecurity Access Scale
  • Radimer/Cornell Hunger Scale
  • USDA’s US Household Food Security Scale
  • USDA’s US Adult Food Security Scale
  • USDA’s US Six Question Food Security Scale

Common characteristics:

  • All scales are free of cost.
  • All necessary information is available to analyze  the results of each survey, free of cost.
  • Relatively short administration times

Which scale should I use? 

Scales: Analysis, Examples and Research using each Scale

1. Household Food Insecurity Access Scale 

  • Analysis of Data: FANTA has provided all information necessary to analyze data at HFIAS Guide
  • Example of Complete Household Food Insecurity Access ScaleExample HFIA
  • Cost: 0$ 
  • Research Using Scale: 

Examples of Research that used HFIAS: National

Holland A. Kennedy M. Hwang S. The assessment of food security in homeless individuals: a comparison of the Food Security Survey Module and the Household Food Insecurity Access Scale. Public Health Nutrition. 2011: 14(12); 2254–2259.

Vogenthaler N, et al. Food Insecurity and Risky Sexual Behaviors Among Homeless and Marginally Housed HIV-Infected Individuals in San Francisco. AIDS Behavior.  2013: 17; 1688–1693.

Examples of Research that used HFIAS: International

Dewing S. Tomlinson M. Le Roux IM. Chopra M. Tsai AC. Food insecurity and its association with co-occurring postnatal depression, hazardous drinking, and suicidality among women in peri-urban South Africa. Journal of Affective Disorders. 2013: 150; 460-465.

Tang AM. Bhatnagar T. Ramakrishnan R. Dong K. Skinner S. Kumar MS. Wanke CA. Malnutrition in a population of HIV-positive and HIV-negative drug users living in Chennai, South India. Drug and Alcohol Dependence. 2011: 118; 73-77.

2. Radimer/Cornell Hunger Scale 

Examples of Research that uses the Radimer/Cornell Hunger Scale: National

Hendricks K and Gorbach S. Nutritional issues in chronic drug users living with HIV infectionAddition Science and Clinical Practice: Research Review. 2009; 5:16-22.

McMahon JH, Wanke CA, Elliott JH, Skinner S, and Tang AM. Repeated assessments of food security predict CD4 change in the setting of antiretroviral therapy. Journal of Acquired Immune Deficiency. 2011; 58:60-63.

Examples of Research that uses the Radimer/Cornell Measures of Hunger and Food Insecurity: International

Anema A, Chan K, Chen Y, Weiser S, Montaner JSG, and Hogg RS. Relationship between food insecurity and mortality among HIV positive injection drug users receiving antiretroviral therapy in British Columbia, Canada. PLoS One. 2013; 8: e61277.

Leyna GH, Mmbaga EJ, Mnyika KS, and Klepp K.  Validation of the Radimer/Cornell food insecurity measure in rural Kilimanjaro, Tanzania. Public Health Nutrition. 2007; 11:684-689.

3. USDA’s US Household Food Security Survey 

Examples of Research that uses the USDA’s US Household Food Security Survey: National

McMahon JH, Wanke CA, Elliott JH, Skinner S, Tang AM. Repeated assessments of food security predict CD4 change in the setting of antiretroviral therapy. Journal of Acquired Immune Deficiency Syndromes 2011; 58:60-63.

Quandt SA, Shoaf JI, Tapia J, Hernandez-Pelletier M, Clark HM, Arcury TA. Experiences of latino immigrant families in north carolina help explain elevated levels of food insecurity and hunger. The Journal of Nutrition 2006; 136: 2638-2644. 

4. USDA’s US Adult Food Security Survey 

5. USDA’s US Six Question Food Security Survey 

Short survey that can determine a household’s risk for food insecurity within 3 questions.

References:

Aberman N, Rawat R, Drimie S, Claros JM, and Kadiyala S. Food Security and Nutrition Interventions in Response to the AIDS Epidemic: Assessing Global Action and Evidence. AIDS Behavior. 2014 [Epub ahead of print]. 

Brandeis University. “Social and economic cost of hunger and food insecurity in US in 2010 was $167.5 billion.” ScienceDaily. ScienceDaily, 5 October 2011. <www.sciencedaily.com/releases/2011/10/111005131705.htm>.

Coates J, Swindale A, and Bilinsky P. Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide Version 3. FANTA and USAID. 2007. <http://www.fao.org/fileadmin/user_upload/eufao-fsi4dm/doctraining/hfias.pdf>.

Coleman-Jensen A, Nord M, and Singh A. Household Food Security in the United States in 2012. Economic Research Service: USDA. September 2013.

Cook J and Jeng K. “Child Food Insecurity: The Economic Impact on our Nation. Feeding America.” 2009. <http://feedingamerica.org/SiteFiles/child-economy-study.pdf>.

Cornell-Radimer hunger scale measures household food security in Java. 2002. Field Exchange 15 <http://www.ennonline.net/fex/15/cornell>.

Crum-Cianflone N, Tejidor R, Medina S, Barahona I, and Ganesan A. Obesity Among HIV Patients: The Latest Epidemic. AIDS Patient Care STDS. 2008; 22(12): 925-930.

Economic Research Service, USDA. U.S. Adult Food Security Survey Module Three-Stage Design, with Screeners. 2012.<http://www.ers.usda.gov/datafiles/Food_Security_in_the_United_States/Food_Security_Survey_Modules/ad2012.pdf>.

Economic Research Service, USDA. U.S. Household Food Security Survey Module: Three-Stage Design, with Screeners. 2012.<http://www.ers.usda.gov/datafiles/Food_Security_in_the_United_States/Food_Security_Survey_Modules/hh2012.pdf>.

Economic Research Service, USDA. U.S. Household Food Security Survey Module: Six-Item Short Form. 2012.<http://www.ers.usda.gov/datafiles/Food_Security_in_the_United_States/Food_Security_Survey_Modules/short2012.pdf>.

FAO, IFAD, and WFP. “The State of Food Insecurity in the World 2013: The multiple dimensions of food security.” 2013. Rome,FAO.

Gillespie S, Haddad L, and Jackson R. HIV/AIDS: Food and Nutrition Security: Impacts and Actions. Prepared for the 28th Session of the ACC/SCN Symposium on Nutrition and HIV/AIDS. 2001.

HIV and Nutrition.” AVERT: Averting HIV and AIDS. <http://www.avert.org/hiv-and-nutrition.htm>.

Newell ML, Borja MC, Peckham C and European Collaborative Study. Height, weight, and growth in children born to mothers with HIV-1 infection in Europe. Pediatrics. 2003; 111(1): e52-60.

Panel to Review the U.S. Department of Agriculture’s Measurement of Food Insecurity and Hunger. Food Insecurity and Hunger in the United States: An Assessment of the Measure. 2006. <http://www.nap.edu/catalog.php?record_id=11578>.

Tang AM, Forrester J, Spiegelman D, Knox TA, Tchetgen E, and Gorbach SL. Weight loss and survival in HIV-positive patients in the era of highly active antiretroviral therapy. Journal of Acquired Immune Deficiency Syndrome. 2002; 31(2): 230-6.

Wang EA, McGinnis KA, Fiellin DA, Goulet JL, Bryant K, Gibert CL, et al. Food Insecurity is Associated with Poor Virologic Response among HIV-Infected Patients Receiving Antiretroviral Medications. J Gen Intern Med. 2011; 26(9): 1012-1018.

Weiser SD, Bangsberg DR, Kegeles S, Ragland K, Kushel MB, and Frongillo EA. Food Insecurity Among Homeless and Marginally Housed Individuals Living with HIV/AIDS in San Francisco. AIDS Behavior. 2009; 13(5): 841-848.

Weiser SD, Frongillo EA, Ragland K, Hogg RS, Riley ED, and Bangsberg DR. Food Insecurity is Associated with Incomplete HIV RNA Suppression Among Homeless and Marginally Housed HIV-infected Individuals in San Francisco. Journal of General Internal Medicine. 2008; 24(1): 14-20.

Weiser SD, Tsai AC, Gupta R, Frongillo EA, Kawuma A, Senkungu J, et al. Food insecurity is associated with morbidity and patterns of healthcare utilization among HIV-infected individuals in a resource-poor setting. AIDS. 2012; 26(1): 67-75.

Weiser SD, Young SL, Cohen CR, Kushel MB, Tsai AC, Tien PC, et al. Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. The American Journal of Clinical Nutrition. 2011: 94(suppl);1729S–39S.

World Food Program. UNAIDS Policy Brief: HIV, Food Security, and Nutrition. May 2008. <http://one.wfp.org/food_aid/doc/JC1515-Policy_Brief_Expanded.pdf>.

World Health Organization. “Food Security.” 2014. Accessed July 21, 2014. <http://www.who.int/trade/glossary/story028/en/>.

World Health Organization. “Nutrition and HIV/AIDS.” Accessed July 21, 2014. <http://www.who.int/nutrition/topics/nut_hiv_tagmeeting_flyer.pdf>.