Food security among people living with HIV: A review of programs and evidence in resource-limited settings

Abstract

Food insecurity, which is prevalent among people living with human immunodeficiency virus (PLHIV), predicts poor treatment and health outcomes. In resource-limited settings, various programs have been implemented to improve access to food and mitigate adverse effects. This study aims to review existing food security programs and assess their evidence of effectiveness in improving food security, medication adherence, and other health outcomes of PLHIV in resource-limited settings. We conducted a review of the published literature on food security and HIV. We narrowed our review of food security programs to interventions that had been implemented in resource-limited settings. Programs can be classified into three categories - food assistance, livelihood development, and combined food assistance and livelihood support. Programs have varying degrees of feasibility and sustainability. The three programs also differ in terms of available empirical evidence to support effectiveness. Of the three categories, food assistance is the most evaluated program, followed by livelihood development and combined food and livelihood support. Current programs offer promising results in increasing access to food and improving key treatment and health outcomes, including adherence to antiretroviral therapy and nutrition. Future programmatic interventions should be appropriate and relevant to the needs and characteristics of PLHIV and their local contexts. Future programs, particularly those that provide livelihood assistance, also need to be rigorously evaluated to increase what we know about impacts on food security, medication adherence, and other health outcomes.