(P17) Food security, viral suppression and depression in migrant workers living with HIV in Chiang Mai, Thailand
Carl Fredrik Sjöland, Patou Musumari Masika, Arunrat Tangmunkongvorakul, Anna Mia Ekström, Susanne Rautiainen
Karolinska Institutet - Global and Sexual Health research group - Department of Public Health Sciences - Sweden, Kyoto University - Global Health Interdisciplinary Unit - Japan , Chiang Mai University - Research Institute for Health Sciences- Thailand, Karolinska University Hospital - Department of Infectious Diseases - Sweden
Migrant populations face higher risks of HIV infection and poor HIV outcomes than the general population. Food insecurity (i.e. uncertain access to food; frequent hunger and food-related anxiety) may aggravate risky sexual behaviours, undermine adherence to antiretroviral treatment (ART), and harm mental wellbeing and quality of life (UNAIDS’ 4th 90 goal) for people living with HIV. However, previous research on the relationship between food insecurity and HIV treatment outcomes is scarce. The aim of this study was to investigate how food insecurity is associated with viral suppression, adherence to ART, and mental well-being among vulnerable migrant workers, mainly from Myanmar, living with HIV in northern Thailand.
A cross-sectional study was conducted in 2018 in the Chiang Mai Province, Thailand, including 316 (203 women and 113 men) migrant workers living with HIV and on ART. Data on socio-demographics, type and duration of ART , adherence, and other HIV related questions, physical and mental health, quality of life, sexual behaviour, and food security was collected through face-to-face interviews and routine clinical and laboratory data from patient health records at 11 separate HIV treatment clinics. Food security during the past 4 weeks was measured using the validated Household Food Insecurity Access Scale (HFIAS-III), categorizing participants into 3 groups (mild, moderate and severe) by combined measures of hunger, socially unacceptable ways of accessing food, and perceived quality of food. Self-reported ART-adherence was measured using a short scale, categorizing participants as optimally (>95%) or sub-optimally (<95%) adherent. Viral load was measured using each clinic’s standard laboratory equipment (viral suppression was defined as <50 copies/ml). Presence of depressive symptoms was measured using the validated Patient Health Questionnaire-9. Crude and multivariable-adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated to investigate associations between food insecurity and viral suppression, self-reported adherence, and symptoms of depression.
Overall prevalence of food insecurity (mild to severe) was 48.7% (n=162), while 14.2% (n=45) reported severe food insecurity indicating frequent lack of food, including having nothing to eat for repeated 24 hour periods. The majority of participants self-reported adequate ART-adherence (96.8% n=305) and most were virally suppressed (93.5% n=290). Only a few reported (4.1% n=13) symptoms of clinical depression. In multivariable-adjusted analyses, food insecurity was associated with not being virally suppressed (OR=6.18, CI=1.64–23.24), perceived poverty/insufficient income (OR=5.02, CI=1.93–13.05), and symptoms of clinical depression (OR=4.81, CI=1.02–22.73).
Despite high levels of viral suppression, we found a high prevalence of food insecurity. In addition, migrants with food insecurity had higher odds of not being virally suppressed and of having depressive symptoms, hindering the 4th 90 goal of good quality-of-life in people living with HIV. Migrants represent an important and often neglected key population for HIV control and quality of care. Larger studies are needed to explore the associations between food insecurity and HIV outcomes in low-/lower-middle income contexts to identify new interventional approaches to reduce food insecurity and improve quality of life among people living with HIV.