Date Published: March 6, 2019
Publisher: Public Library of Science
Author(s): Amy A. Conroy, Mardge H. Cohen, Edward A. Frongillo, Alexander C. Tsai, Tracey E. Wilson, Eryka L. Wentz, Adaora A. Adimora, Daniel Merenstein, Ighovwerha Ofotokun, Lisa Metsch, Mirjam-Colette Kempf, Adebola Adedimeji, Janet M. Turan, Phyllis C. Tien, Sheri D. Weiser, Michael L. Goodman.
Food insecurity and violence are two major public health issues facing U.S. women. The link between food insecurity and violence has received little attention, particularly regarding the temporal ordering of events. The present study used data from the Women’s Interagency Human Immunodeficiency Virus Study to investigate the longitudinal association of food insecurity and violence in a cohort of women at risk for or living with HIV.
Study participants completed six assessments from 2013–16 on food insecurity (operationalized as marginal, low, and very low food security) and violence (sexual or physical, and psychological). We used multi-level logistic regression, controlling for visits (level 1) nested within individuals (level 2), to estimate the association of experiencing violence.
Among 2,343 women (8,528 visits), we found that victims of sexual or physical violence (odds ratio = 3.10; 95% confidence interval: 1.88, 5.19) and psychological violence (odds ratio = 3.00; 95% confidence interval: 1.67, 5.50) were more likely to report very low food security. The odds of experiencing violence were higher for women with very low food security at both the current and previous visit as compared to only the current visit. HIV status did not modify these associations.
Food insecurity was strongly associated with violence, and women exposed to persistent food insecurity were even more likely to experience violence. Food programs and policy must consider persistent exposure to food insecurity, and interpersonal harms faced by food insecure women, such as violence.
Food insecurity, defined as having limited access to food and ability to acquire food , and physical, sexual, and psychological violence are two major public health problems affecting women in the United States (U.S.). Nationally-representative data show that female-headed households experience significantly higher rates of food insecurity as compared to households in general (30% versus 13%) . Women in the U.S. also experience high rates of violence with at least 25% of women having experienced physical or sexual violence over their lifetime. Food insecurity can have significant impacts on women’s mental and physical health including depression and substance abuse, human immunodeficiency virus (HIV) infection, and HIV-related morbidity and mortality through nutritional, mental health (e.g., depression), and behavioral (e.g., non-adherence to HIV medication) pathways . Similarly, violence can lead to physical injury, chronic disease, depression, post-traumatic stress disorder, substance abuse, and sexually-transmitted infections [5, 6]. Rates of violence and food insecurity among HIV-positive women are high. Between 14–20% of U.S. women reported physical violence in the past six months  and an estimated 50% of HIV-positive individuals, including women, are food insecure .
At baseline (N = 2,553), the mean age was 47 years old, 64% had a high school education or less, 72% were non-Hispanic Black, and 62% reported having a current partner (Table 1). Consistent with the WIHS study design, 71% were HIV-positive. Almost 45% of women experienced food insecurity (defined as having marginal, low, or very low food security) in the past six months. In the past six months, 4.5% of women experienced sexual or physical violence and 4.4% of women experienced psychological violence.
In this longitudinal cohort of women, many of whom were living with HIV, we found that food insecurity—either at the prior or current visit—was positively associated with current violence even after adjusting for socio-economic status. This finding held for sexual or physical violence, and psychological violence. We also provide the first longitudinal evidence that being food insecure at a prior study visit is associated with subsequent experiences of violence. Additionally, women who experienced persistent, severe food insecurity were more likely to experience violence than women who experienced shorter periods of severe food insecurity.