Effect of pregnancy gestation on food insecurity in HIV-positive women from Kisumu and Migori Counties in Western Kenya

Abstract

Background: Food insecurity has been associated with adverse health outcomes among vulnerable populations including women, children, and persons infected with HIV. Little is known about the relationship between pregnancy and food insecurity among HIV-positive women. Methods: A cross-sectional analysis of data from HIV-infected women in Migori and Kisumu Counties in western Kenya was performed using univariate and multivariate linear regression to examine the association between pregnancy, modeled as gestational age (0->40 weeks), and food insecurity based on the Household Food Insecurity Access Scale (HFIAS). A subgroup analysis restricted to the pregnant women only was performed to examine this association. Results: A total of 1034 HIV-positive women were included in this study, of whom 106 (10.3%) were pregnant, and 928 (89.8%) were not pregnant at enrollment. Participants ranged in age from 18-49 years, with a median age of 30 years (inter-quartile range [IQR] 25-35) for non-pregnant women and 26 years (IQR 23-29) for pregnant women. The median gestational age among 106 pregnant women was 19 (IQR 13-27) weeks. Among all women, 227/1034 (23%) did not experience any food insecurity. The median food insecurity score was 6 for non-pregnant (IQR 2-12) and 6 for pregnant women (IQR 0-12). In unadjusted analysis, there was a weak negative association between gestational age and HFIAS score (β=-0.048, 95% confidence interval [CI] -0.096, 0.000, p=0.049) which was of borderline statistical significance This association was no longer present after adjusting for age, marital status, education, and CD4 count in (β=-0.016, 95% CI -0.064, 0.035, p=0.504). A number of covariates were significantly associated with HFIAS scores. These included age (β=0.131, 95%, CI, 0.089, 0.0175, p<0.001 , being married (β=-0.742, 95%, CI,-1.400,-0.085, p=0.027), and having secondary (β=-1.722, 95% CI -2.434,-1.010, p<0.001 or college/university (β=-3.833, 95% CI -5133,-2.533, p<0.001 education compared to primary education or less. Conclusions: In this population of HIV-positive women, there was no association between advancing gestational age and food insecurity Younger age, higher education, and being married were associated with less food insecurity, suggesting that social, cultural, and economic factors may be drivers of food insecurity in HIV-positive women.