Comparison of food insecurity between HIV/AIDS affected households on food assistance and those not on food assistance in Uganda

Abstract

Food insecurity is an important factor that may affect nutrition status of individuals in the household. HIV/AIDS impedes the food security of affected people drastically decreasing the labor, income, assets, food reserves, savings, information exchange, institutional support, and community safety nets available to affected households. In an effort to strengthen food and nutritional security in households affected by HIV/AIDS, food assistance programs have been in operation for years now, even in Uganda. Little has been documented about the suitability of the targeting criteria used for selecting food assistance beneficiaries. The objective of this study was to determine factors associated with food insecurity among households affected by HIV/AIDS in Uganda with a view of recommending criteria for recruitment of people living with HIV/AIDS (PLWHA) into food assistance programs.

A cross-sectional study was performed among The AIDS Support Organization (TASO) Mbarara clients’ households in selected final distribution points (FDPs) in Bushenyi and Mbarara Districts; Title II HIV/AIDS initiative program implementing partner (IPs) which has the largest number of food aid HIV clients in the country. From a sampling frame of households meeting the selection criteria, a total of 301 households: 153 on food assistance and 148 not on food assistance were selected. These were interviewed to determine household demographic, socio-economic, and food production and consumption information. Food insecurity was evaluated using the fourteen Food and Agriculture Technical Assistance (FANTA) standardized household food insecurity scale model questions that determine the household food insecurity scale score (HFISS).

There was no significant difference (p>0.05) between the two household categories in mean age, level of education, occupation, household size, dependence ratio, type of housing, food sources and production, access to water sources, and asset ownership. The food assisted households had a significantly larger number of orphan and vulnerable children (OVCs) than the non-food assisted (p<0.001). The food assisted had significantly more female household heads than non-food assisted (p<0.001). Correlation analysis showed no significant difference (p>0.05) in HFISS between food assisted and non-food assisted households. However, on categorizing the households into three food insecurity categories, there was an overall significant difference in food insecurity status between the household groups (p=0.037). The significant difference (p=0.01) between the household groups was in the moderately food insecure category but not in the other two categories of food insecurity. Overall, 21% of households included in the study were found to be food secure, 42% moderately food insecure, and 37% severely food insecure. On the contrary, the food assisted households were found to have a more diverse diet compared to their counterparts (p=0.039). The difference was attributed to additional nutrition training food aid beneficiaries received at FDPs and the frequent snacking by food beneficiaries using the food assistance commodities. High levels of food insecurity were found to be associated with low attendance of health and nutrition talks (p<0.001), low number of meals eaten in previous 24 hours (p<0.001), low socio-economic status of the household (p=0.029), and low variety of crops the household grew (p=0.005). Unlike in other studies, high attendance of HIV/AIDS awareness seminars (p=0.039), one to one counseling sessions (p=0.003), and high household livestock units were found to be associated with high food insecurity levels.

The results of this study also show that the criteria currently used to recruit beneficiaries into food assistance programs do not identify the most food insecure HIV/AIDS affected households. Programs seeking to provide food assistance in the context of HIV/AIDS should explore targeting criteria that include a mixture of socio-demographic and food insecurity/vulnerability variables if they are to select the most vulnerable.

More research is needed to establish how to enhance food security among households of PLWHA and whether factors associated with food insecurity among HIV/AIDS affected households and general population are similar.