Malnutrition Among People Who Inject Drugs (PWID) Living with HIV in Kenya: A Cross-sectional Analysis

Abstract

Background: People who inject drugs (PWID) living with HIV face heightened vulnerability to malnutrition and food insecurity, both of which can compromise immune function and antiretroviral therapy (ART) adherence. Although these issues are well documented globally, there is limited research in sub-Saharan Africa, particularly in Kenya, where HIV prevalence among PWID is over four times the national average. This study aimed to examine the prevalence and predictors of abnormal weight status among PWID living with HIV in Kenya to inform targeted, integrated interventions. Methods: This cross-sectional study analyzed secondary data from PWID living with HIV in Nairobi and Kenya’s coastal region. Abnormal weight was defined as either underweight (BMI <18.5) or overweight/obese (BMI ≥25), with normal weight as the reference category. Univariate and multivariate logistic regression analyses were used to identify sociodemographic, behavioral, and clinical factors associated with abnormal weight status. Results: Among 223 participants, 34.1% were underweight and 10.3% overweight/obese. In multivariate analysis, male sex was significantly associated with underweight status. While marital status and alcohol use were not independently significant in the multivariate analysis, they were both positively associated with BMI in univariate analyses. Conclusion: Findings highlight the coexistence of undernutrition and emerging trends of overnutrition among PWID living with HIV in Kenya, two distinct but important challenges. Nutritional vulnerability in this population is shaped by multiple factors, including substance use patterns, gender, and lack of social support. Integrating tailored nutrition interventions into HIV care and harm reduction services are critical to address these intersecting needs.