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Prevalence and correlates of self-reported hunger among HIV+ and HIV- injection drug users in Canada
A. Anema1,2, T. Kerr1,2, S.D. Weiser3, J.S.G. Montaner1,2, E. Wood1,2
1British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, 2University of British Columbia, Vancouver, Canada, 3University of California, San Francisco, San Francisco, United States
Background: Inadequate food intake is associated with increased HIV risk behaviors among uninfected individuals, and with reduced CD4 cell counts, virological suppression and chance of survival among people living with HIV. North American studies suggest hunger is common among injection drug users (IDU). However, little is known about the determinants of hunger among this population and the differential effect according to HIV status.
Methods: We examined the prevalence and correlates of hunger among HIV at-risk and infected IDU in British Columbia, Canada. We measured self-reported frequent hunger as our dependent variable, defined as the inability to afford food and/or as the procurement of drugs instead of food. In bivariate analysis, prevalence of hunger was examined in relation to socio-demographic and drug using characteristics.
Results: Among 1,030 HIV-at-risk and 419 HIV-infected individuals, 692 (67%) and 268 (64%) reported hunger, respectively. In multivariate analysis, self-reported hunger was significantly associated with older age (Odds Ratio [OR] = 0.98 [95%: CI 0.96-1.00]), unstable housing (odds ratio (OR) 1.88 [95%: CI 1.33-2.65]), spending >$50 daily on drugs (OR 1.68 [95%: CI 1.18-2.39]), daily heroin injection (OR 2.07 [95%: CI 1.32-3.23]), and rock/crack binge in the last six months (OR 1.99 [95%: CI 1.34-2.95]); among HIV at-risk individuals. In comparison, among HIV-infected participants, hunger was correlated with receiving welfare income (OR 0.49 [95%: CI 0.28-0.84]), spending >$50 daily on drugs (OR 2.71 [95%: CI 1.56-4.72]), and rock/crack binge in the last six months (OR 2.79 [95%: CI 1.53-5.11]).
Conclusion: Self-reported hunger is elevated among HIV at-risk and HIV-infected IDU in a high resource setting, and HIV-positive and negative IDU demonstrated differential risk factors for hunger.
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