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How food insecurity affects people living with HIV—and why we need to care

, by Emily Newman

table with foodStudies have found that about half of people living with HIV in the U.S. are “food insecure”—or don’t have regular access to enough nutritious food to maintain their health. In San Francisco, a study by Weiser and colleagues published in Journal of General Internal Medicine revealed that 48% of people living with HIV in medical care are food insecure—with an even higher percentage likely food insecure if including people not in medical care.

That’s one of the reasons why HIV organizations like San Francisco AIDS Foundation incorporate meals into their community programs. Alfredo De Labra, treatment advocacy coordinator for Positive Force, explained to BETA why this program serves hot food to clients. “For some clients, this may be the only hot meal they get for the day or even the week,” he said. “I believe it’s important to serve food because it brings people together—kind of like a camp or beach bonfire. People gather around it and then the magic of connection happens. A client told me last night, ‘I look forward to events like this where we get to sit down and eat a meal together, it beats microwaving my food and eating alone in my SRO.’”

What’s the link between regular access to affordable, nutritious food and HIV health—and what can we do to help people living with HIV improve their health with more consistent access to healthy food? That was the topic explored by Sheri Weiser, MD, MPH and Hilary Seligman, MD, MAS at a recent HIV Grand Rounds presentation at Zuckerberg San Francisco General Hospital.

“As far as not knowing where your next meal is going to come from—OK, right there, that’s stress in itself.” –Project Open Hand client, quote from Sheri Weiser, MD, MPH presentation

Having to beg or rely on charity for food—or not having access to healthy food—is food insecurity

Weiser started the presentation by offering the definition of food insecurity: “Access, by all people, at all times, to enough food for an active, healthy life.”

It can encompass more, she said, than simply not having enough to eat. Food insecurity can also include: poor quality and diversity of food; feeling anxiety and having restricted choice about the amount and types of food that are available; worrying where your next meal will come from; and being unable to get food in personally and socially acceptable ways.

“For some, it may not be socially acceptable to beg or steal for food, or to rely on charity for food,” she said. People who have to rely on food banks or going to soup kitchens to feed themselves or their family may be “food insecure.”

Only eating a small variety of foods, binging when food is available, and eating mostly highly-filling foods can be signs of food insecurity, explained Seligman. “If your patients tell you, ‘I eat oatmeal for lunch every single day,’ in my mind that is almost diagnostic of food insecurity in this city.”

Could you afford food on $4.75 per day?

Although there are supplemental food programs to help low-income people in San Francisco—and around the nation—pay for food, oftentimes they are not enough. People who qualify for CalFresh (federally known as the Supplemental Nutrition Assistance Program [SNAP]) have on average $4.75 per day to spend on food.

“Remember that even though CalFresh benefits are intended to be supplemental, the majority—more than 60%—of people on SNAP benefits only have that $4.75 to spend per day,” said Seligman.

When shopping for food, it’s more cost effective to buy things like bread, pasta, and rice than fresh fruits and vegetables. “In fact, five servings of fruit and vegetables a day, which the USDA recommends for a healthy diet, would require a low-income family to spend up to 70% of their entire food budget on fruits and vegetables,” said Seligman.

It’s a “vicious cycle” of food insecurity and HIV

Weiser made the point that food insecurity and HIV are closely tied. They’re linked by things like poorer mental health (e.g., depression, anxiety) and worse adherence to HIV medications.

“A hungry person can’t think and focus on health plans or develop health goals like achieving viral load suppression, explained Jorge Zepeda, ACSW, MSW, Latino Programs manager for San Francisco AIDS Foundation. “Providing food to clients is very important because food facilitates connectedness from one human to another. Our services are based on trust and engagement, and food is a powerful tool to connect and motivate [clients] to come back to the foundation.”

Weiser read aloud a quote from a Project Open Hand client, who said, “You have to eat when you take ART and other medications. If I don’t have any food when I take my medication, then I’ll get sick and I’ll get mad, then I don’t want to take the pills.”

“You can see consistent findings from multiple U.S. settings linking food insecurity to unsuppressed viral load and lower CD4 cell counts,” said Weiser.

She also shared research showing that people with food insecurities are at higher risk for mortality and are more likely to use expensive healthcare services.

One study found that in San Francisco, people who are food insecure have about twice the odds of being hospitalized and a 71% higher odds of a recent ER visit.

“Food is medicine,” said Weiser. “Food support interventions reduce healthcare utilization. They can improve nutritional status, mental health, health behaviors, and even lead to improvements in HIV health outcomes.”

Food is medicine

Food programs aren’t very costly to sustain, and they benefit people who need better access to food immensely.

Seligman recommended the following for people who are food insecure:

  • Find out about food assistance programs. About half of Californians who are eligible for SNAP are not enrolled. There are also other food programs like Meals on Wheels, food pantries and soup kitchens that can help during times of food scarcity.
  • Buy frozen fruits and vegetables rather than canned fruits and vegetables (they’re healthier).
  • Try to shop at farmers’ markets to find more affordable produce (avoid the market at the San Francisco Ferry Building, though, since it’s expensive).

Food resources in San Francisco

CalFresh can help you buy health and nutritious food with monthly electronic benefits that can be used at many markets and grocery stores. Call the toll free number 1.877.847.3663 or look online at www.calfresh.ca.gov/.

Heart of the city farmer’s market at United Nations Plaza along Market Street between 7th and 8th. Call our information line at 415.558.9455 with questions. The market is held year-round on Sundays from 7 am to 5 pm, and Wednesdays from 7 am to 5:30 pm.The

SF-Marin Food Bank provides access to weekly groceries and emergency food. You do not need to be a legal resident to access services. Call 415.282.1900 for more information or visit https://foodlocator.sfmfoodbank.org/ to find pantries and emergency food in your area.

GLIDE provides daily meals in the Tenderloin neighborhood of San Francisco at 330 Ellis Street. Breakfast is served from 8 to 9 am; lunch from noon to 1:30 pm, and dinner from 4 – 5:30 pm.    For additional resources on where to eat for free in San Francisco, check out the Free Eats Chart.

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