Grant: Travel Awards - Institute Community Support

BACKGROUND: In HIV-positive populations, food insecurity (FI), which refers to "limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways", is associated with poor HIV treatment adherence and adverse health outcomes. Among HIV-hepatitis C virus (HCV) co-infected populations, injection drug use (IDU) may be a particularly important risk factor for FI. This study examines the relationship between recent IDU and FI among HIV-HCV co-infected individuals in Canada. METHODS: This analysis used data collected biannually from questionnaires (N=642 in 17 centres across 6 provinces, November 2012-March 2015). FI in the past 6 months was measured using a tool developed by Health Canada and categorized as: food secure; marginal, moderate, or severe FI. Recent IDU (in the past 6 months) was self-reported. Statistical models were used to estimate the effect of recent IDU on FI. RESULTS: Among 642 participants, 31% recently injected drugs and 64% (7% marginal, 23% moderate, 34% severe) experienced FI. Recent IDU was significantly associated with FI; the odds of experiencing FI were 39% higher in those who engaged in recent IDU, compared to those who did not recently inject drugs, after considering other factors such as: age, sex, province, Aboriginal status, housing, education, employment, income, previous IDU (beyond the past 6 months), other substance use (recent alcohol, cigarette, or marijuana use), other modes of recent drug use (snorting), recent anxiety or depression, and self-described health state. CONCLUSIONS: Recent IDU is a significant risk factor for FI. Given a high prevalence of IDU, substance abuse treatments and the integration of food supports in harm reduction programs (e.g., opioid substitution programs and supervised injection services) may mitigate FI and its impacts on health in this vulnerable sub-set of the HIV-positive population.