Food Insecurity and Financial Instability Linked to HIV

Proper nutrition leads to improved outcomes and increased CD4 T-cell counts.

Seventy-one percent of the world’s population infected with HIV resides in sub-Saharan Africa, which translates to 24.7 million people living with one of the world’s most infectious diseases.

What makes the people in this region so vulnerable to contracting the disease? A recent study revealed that poverty and food insecurity could be at the heart of HIV outcomes in some parts of Africa.

According to a randomized, controlled trial led by researchers at UC San Francisco, a multifaceted farming intervention can reduce food insecurity while improving HIV outcomes in Kenya. Participants in the study were able to increase the quantity and quality of food consumed, which led to CD4 T-cell counts increasing as well. Additionally, the rate of viral suppression increased by about one-half, along with the quality and quantity of food consumed. Those in the control arm who did not receive assistance experienced decreases in CD4 cell counts and rate of suppression.

“While this was a pilot study, these results prove the concept that improving food insecurity and alleviating poverty can affect HIV clinical outcomes,” said the co-primary investigator, Sheri D. Weiser, MD, MPH.

In sub-Saharan Africa, there are 240 million people classified by researchers as food insecure. Food insecurity increases the risk of becoming infected with HIV, as food insecure people with HIV are less able to sustain anti-HIV therapies, make clinical visits, and have poor nutritional status. The combination of these factors make treating and preventing HIV much more difficult in the region, resulting in sicker patients and more deaths.

As a result, food insecurity increases with the prevalence of HIV cases as economic activity and productivity grind to a halt. This vicious cycle may also be the cause of high HIV rates reported in the area.

“HIV/AIDS and food insecurity are intertwined in a vicious cycle, with each increasing vulnerability to and exacerbating the severity of the other,” Weiser said. “We have the biomedical tools to treat and prevent HIV, but we need interventions like this that combine healthcare with development, and address food insecurity, poverty and disempowerment if we are to achieve the UNAIDS goal of ending the HIV/AIDS epidemic by 2030.”

The study involved 2 groups of HIV positive individuals between 18 and 49 years of age, who were on anti-HIV therapy and had access to surface water for irrigation and land. Microfinance loans were used to purchase farming equipment and tools, along with irrigation pumps designed by KickStart, a nonprofit organization that develops and markets new technologies that are used to establish new small businesses.

“The pumps make it possible for farmers to irrigate year round, which reduced dependence on seasonal rainfalls. Producing food year round enables farmers to move from subsistence farming to commercial farming and also allows them to capture higher crop prices during the dry season,” said co-primary investigator, Craig R. Cohen, MD, MPH.

The third component of the study involved agricultural and financial management training. Agricultural training included practical demonstration on sustainable farming techniques, use of water pump planting, soil and water conservation and integrated disease and pest management. Financial training involved record keeping seminars as well as lessons on savings and investments.

“This is the first trial to link agriculture with HIV outcomes,” Cohen said. “The intervention is unique in that it is sustainable, transformative and empowering. If you were to take away our involvement tomorrow, the knowledge and materials to continue the livelihood intervention would still exist in the community.”