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Food Insecurity, Internalized Stigma, and Depressive Symptoms Among Women Living with HIV in the United States

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Abstract

Food insecurity, internalized HIV stigma, and depressive symptoms are independently associated with poor HIV outcomes. Food insecurity, stigma, and depression may be interrelated among women living with HIV (WLHIV). We hypothesized that food insecurity would be independently associated with internalized stigma and depressive symptoms among WLHIV in the United States (US), and would partially account for associations between stigma and depressive symptoms. We tested hypotheses using regression models and partial correlation analysis with cross-sectional data among 1317 WLHIV from the Women’s Interagency HIV Study. In adjusted models, greater food insecurity was associated with internalized HIV stigma and depressive symptoms (all p < 0.05), exhibiting dose–response relationships. Food insecurity accounted for 23.2% of the total shared variance between depressive symptoms and internalized stigma. Food insecurity is associated with depressive symptoms and internalized HIV stigma among US WLHIV, and may play a role in the negative cycle of depression and internalized stigma.

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Funding

This study was funded by a Women’s Interagency HIV Study (WIHS) sub-study grant from the National Institute of Mental Health, R01MH095683 (Weiser). Additional salary support was provided by K01DK107335 (Palar). Data in this manuscript were collected by the Women’s Interagency HIV Study (WIHS). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). WIHS (Principal Investigators): UAB-MS WIHS (Michael Saag, Mirjam-Colette Kempf, and Deborah Konkle-Parker), U01-AI-103401; Atlanta WIHS (Ighovwerha Ofotokun and Gina Wingood), U01-AI-103408; Bronx WIHS (Kathryn Anastos), U01-AI-035004; Brooklyn WIHS (Howard Minkoff and Deborah Gustafson), U01-AI-031834; Chicago WIHS (Mardge Cohen and Audrey French), U01-AI-034993; Metropolitan Washington WIHS (Seble Kassaye), U01-AI-034994; Miami WIHS (Margaret Fischl and Lisa Metsch), U01-AI-103397; UNC WIHS (Adaora Adimora), U01-AI-103390; Connie Wofsy Women’s HIV Study, Northern California (Ruth Greenblatt, Bradley Aouizerat, and Phyllis Tien), U01-AI-034989; WIHS Data Management and Analysis Center (Stephen Gange and Elizabeth Golub), U01-AI-042590; Southern California WIHS (Alexandra Levine and Marek Nowicki), U01-HD-032632 (WIHS I – WIHS IV). The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women’s Health. WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA) and UL1-TR000454 (Atlanta CTSA).

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Authors and Affiliations

  1. Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco (UCSF), 995 Potrero Avenue, Bldg 80, Ward 84, Campus Box 0874, San Francisco, CA, 94110, USA

    Kartika Palar, Lila A. Sheira & Sheri D. Weiser

  2. Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA

    Edward A. Frongillo & Jessica Escobar

  3. Department of Community Health Sciences, School of Public Health, State University of New York Downstate Medical Center, Brooklyn, NY, USA

    Tracey E. Wilson

  4. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Adebola Adedimeji

  5. Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA

    Daniel Merenstein

  6. Department of Medicine, Stroger Hospital, Chicago, IL, USA

    Mardge H. Cohen

  7. Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA

    Eryka L. Wentz

  8. School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Adaora A. Adimora

  9. School of Medicine, Emory University, Atlanta, GA, USA

    Ighovwerha Ofotokun

  10. Grady Healthcare System, Atlanta, GA, USA

    Ighovwerha Ofotokun

  11. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA

    Lisa Metsch

  12. Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

    Phyllis C. Tien

  13. Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA, USA

    Phyllis C. Tien

  14. Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    Janet M. Turan

  15. Center for AIDS Prevention Studies, UCSF, San Francisco, CA, USA

    Sheri D. Weiser

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  1. Kartika Palar
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  2. Edward A. Frongillo
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  3. Jessica Escobar
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  4. Lila A. Sheira
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  5. Tracey E. Wilson
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  10. Adaora A. Adimora
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  11. Ighovwerha Ofotokun
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  12. Lisa Metsch
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  13. Phyllis C. Tien
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  14. Janet M. Turan
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  15. Sheri D. Weiser
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Correspondence to Kartika Palar.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Board at each study site’s institution and by the WIHS Executive Committee.

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Palar, K., Frongillo, E.A., Escobar, J. et al. Food Insecurity, Internalized Stigma, and Depressive Symptoms Among Women Living with HIV in the United States. AIDS Behav 22, 3869–3878 (2018). https://doi.org/10.1007/s10461-018-2164-8

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