Moderate and severe household food insecurity in families of people living with HIV/Aids: scale validation and associated factors

Medeiros, Amira Rose Costa; Lima, Rafaela Lira Formiga Cavalcanti de; Medeiros, Leidyanny Barbosa de; Trajano, Flávia Maiele Pedroza; Salerno, Amanda Amaiy Pessoa; Moraes, Ronei Marcos de; Vianna, Rodrigo Pinheiro de Toledo

doi:10.1590/1413-812320172210.02462017

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ARTICLE • Ciênc. saúde colet. 22 (10) • Oct 2017 • https://doi.org/10.1590/1413-812320172210.02462017 copy

Moderate and severe household food insecurity in families of people living with HIV/Aids: scale validation and associated factors

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Vulnerable population groups, including people living with HIV/Aids (PLHA), may have a high prevalence of food insecurity (FI). A cross-sectional study evaluated the internal validity of the Brazilian Food Insecurity Scale (Escala Brasileira de Insegurança Alimentar – EBIA) and measured the prevalence of FI in a sample of 796 PLHA in João Pessoa, Paraíba State (PB). The validation was performed using a Rasch analysis. The association of FI with sociodemographic and clinical characteristics was assessed using the chi-square test. Associated variables were included in a Poisson multiple regression model. The EBIA was valid for PLHA with fit values within the expected limits and item severity conforming to the theoretical model. The EBIA identified 66.5% of PLHA with FI in the sample (30.8% mild FI, 18.1% moderate FI and 17.6% severe FI). Moderate FI and severe FI were associated with an age younger than 43 years (prevalence ratio (PR) = 1.49; 95% confidence interval (CI): 1.14-1.86), primary education (PR=1.64; 95% CI: 1.24-2.17), income per capita lower than ½ minimum wage (MW) (PR=1.83; 95% CI: 1.37-2.44), lack of occupation (PR=1.59; 95% CI: 1.16-2.19) and adult-only households with a female reference person (PR=2.19; 95% CI: 1.45-3.31). The PLHA in this study had a high prevalence of FI, worsening their living conditions and potentially exacerbating their health problems.

Food insecurity; EBIA; HIV; AIDS

Household Composition*	Food Security		Mild IA		Moderate IA		Grave IA

	n	%	n	%	n	%	n	%
Adult-only households	193	39.0	123	24.8	78	15.8	101	20.4
Households with adults and minors	74	24.6	122	40.5	66	21.9	39	13.0
Total	267	33.5	245	30.8	144	18.1	140	17.6

Sociodemographic, economic and health variables	Food Security + Mild FI		Moderate + Severe FI		Total Sample		p-value*

	n₁	%	n₂	%	n	%
Age
Up to 43 years (median)	236	60.0	157	40.0	396	100.0	0.013
Older than 43 years	276	68.5	127	31.5	403	100.0
Sex
Female	171	54.8	141	45.2	312	100.0	< 0.001
Male	341	70.4	143	29.6	484	100.0
Per capita income
Up to ½ minimum wage	229	52.9	204	47.1	433	100.0	< 0.001
More than ½ minimum wage	283	78.0	80	22.0	363	100.0
Education**
Up to incomplete primary education	219	52.5	198	47.5	417	100.0	0.001
Incomplete primary education or higher	292	77.4	85	22.5	377	100.0
Marital status **
Living with partner	331	66.1	170	33.9	501	100.0	0.177
Not living with partner	179	61.3	113	38.7	292
Occupation **
Employed/economically active	209	79.5	54	20.5	263	100.0	< 0.001
Unemployed/economically inactive	302	57.2	226	42.8	528
Number of household members
Up to 3	345	65.6	181	34.4	562	100.0	0.297
4 or more	167	61.8	103	38.2	270
Length of diagnosis
Up to 4 years	164	60.5	107	39.5	271	100.0	0.107
Longer than 4 years	348	66.3	177	33.7	525	100.0
Length of TARV use***
Up to 3 years	166	60.8	107	39.2	273	100.0	0.135
Longer than 3 years	346	66.2	177	33.8	523	100.0
BMI**
Underweight	17	58.6	12	41.4	29	100.0	0.337
Normal weight	262	64.7	143	35.3	405	100.0
Overweight	175	67.0	86	33.0	261	100.0
Obesity	52	55.9	41	44.1	93	100.0
Household composition
Only adults	316	63.8	179	36.2	495	100.0	0.715
Adults and minors	196	65.1	105	34.9	301

Variable	Category	PR -adjusted	Confidence Interval (95%)

			Minimum	Maximum
Sex x household composition	Female with an adult-only family	2.191	1.449	3.314
	Male with an adult-only family	1.857	1.247	2.765
	Female with a family of adults and minors	1.632	1.083	2.460
	Male with a family of adults and minors	1
Age	≤ 43 years	1.459	1.143	1.862
	> 43 years	1
Education	Up to incomplete primary education	1.640	1.237	2.174
	Primary education or higher	1
Occupation	Without occupation	1.592	1.156	2.192
	With occupation	1
Income per capita	≤ ½ minimum wage	1.831	1.373	2.442
	> ½ minimum wage	1

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[1] Collaborations

ARC Medeiros, RLFC Lima and RPT Vianna worked on the conception, design, data analysis and interpretation, manuscript writing and approval of the final version. LB Medeiros, FMP Trajano and AAP Salerno worked on the research and methods. RM Moraes worked on the design, data interpretation, critical revision and approval of the final version.