Factors contributing to food insecurity among women living with HIV in the Dominican Republic: A qualitative study
Identifieur interne : 004465 ( Ncbi/Curation ); précédent : 004464; suivant : 004466Factors contributing to food insecurity among women living with HIV in the Dominican Republic: A qualitative study
Auteurs : Kathryn P. Derose [États-Unis] ; Denise D. Payán [États-Unis] ; María Altagracia Fulcar [République dominicaine] ; Sergio Terrero [République dominicaine] ; Ram N Acevedo [République dominicaine] ; Hugo Farías ; Kartika Palar [États-Unis]Source :
- PLoS ONE [ 1932-6203 ] ; 2017.
Abstract
Food insecurity contributes to poor health outcomes among people living with HIV. In Latin America and the Caribbean, structural factors such as poverty, stigma, and inequality disproportionately affect women and may fuel both the HIV epidemic and food insecurity.
We examined factors contributing to food insecurity among women living with HIV (WLHIV) in the Dominican Republic (DR). Data collection included in-depth, semi-structured interviews in 2013 with 30 WLHIV with indications of food insecurity who resided in urban or peri-urban areas and were recruited from local HIV clinics. In-person interviews were conducted in Spanish. Transcripts were coded using content analysis methods and an inductive approach to identify principal and emergent themes.
Respondents identified economic instability as the primary driver of food insecurity, precipitated by enacted stigma in the labor and social domains. Women described experiences of HIV-related labor discrimination in formal and informal sectors. Women commonly reported illegal HIV testing by employers, and subsequent dismissal if HIV-positive, especially in tourism and free trade zones. Enacted stigma in the social domain manifested as gossip and rejection by family, friends, and neighbors and physical, verbal, and sexual abuse by intimate partners, distancing women from sources of economic and food support. These experiences with discrimination and abuse contributed to internalized stigma among respondents who, as a result, were fearful and hesitant to disclose their HIV status; some participants reported leaving spouses and/or families, resulting in further isolation from economic resources, food and other support. A minority of participants described social support by friends, spouses, families and support groups, which helped to ameliorate food insecurity and emotional distress.
Addressing food insecurity among WLHIV requires policy and programmatic interventions to enforce existing laws designed to protect the rights of people living with HIV, reduce HIV-related stigma, and improve gender equality.
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DOI: 10.1371/journal.pone.0181568
PubMed: 28742870
PubMed Central: 5526502
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Hugo Farías<affiliation><nlm:aff id="aff005"><addr-line>United Nations World Food Programme - Regional Bureau for Latin American and the Caribbean, Panamá, Rep. de Panama</addr-line></nlm:aff><wicri:noCountry code="subfield">Rep. de Panama</wicri:noCountry></affiliation>Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Factors contributing to food insecurity among women living with HIV in the Dominican Republic: A qualitative study</title><author><name sortKey="Derose, Kathryn P" sort="Derose, Kathryn P" uniqKey="Derose K" first="Kathryn P." last="Derose">Kathryn P. Derose</name><affiliation wicri:level="2"><nlm:aff id="aff001"><addr-line>Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Payan, Denise D" sort="Payan, Denise D" uniqKey="Payan D" first="Denise D." last="Payán">Denise D. Payán</name><affiliation wicri:level="2"><nlm:aff id="aff001"><addr-line>Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff002"><addr-line>Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Fulcar, Maria Altagracia" sort="Fulcar, Maria Altagracia" uniqKey="Fulcar M" first="María Altagracia" last="Fulcar">María Altagracia Fulcar</name><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>United Nations World Food Programme, Dominican Republic Country Office, Santo Domingo, Dominican Republic</addr-line></nlm:aff><country xml:lang="fr">République dominicaine</country><wicri:regionArea>United Nations World Food Programme, Dominican Republic Country Office, Santo Domingo</wicri:regionArea><wicri:noRegion>Santo Domingo</wicri:noRegion></affiliation></author><author><name sortKey="Terrero, Sergio" sort="Terrero, Sergio" uniqKey="Terrero S" first="Sergio" last="Terrero">Sergio Terrero</name><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>United Nations World Food Programme, Dominican Republic Country Office, Santo Domingo, Dominican Republic</addr-line></nlm:aff><country xml:lang="fr">République dominicaine</country><wicri:regionArea>United Nations World Food Programme, Dominican Republic Country Office, Santo Domingo</wicri:regionArea><wicri:noRegion>Santo Domingo</wicri:noRegion></affiliation></author><author><name sortKey="Acevedo, Ram N" sort="Acevedo, Ram N" uniqKey="Acevedo R" first="Ram N" last="Acevedo">Ram N Acevedo</name><affiliation wicri:level="1"><nlm:aff id="aff004"><addr-line>Consejo Nacional de VIH/SIDA (CONAVIHSIDA), Santo Domingo, Dominican Republic</addr-line></nlm:aff><country xml:lang="fr">République dominicaine</country><wicri:regionArea>Consejo Nacional de VIH/SIDA (CONAVIHSIDA), Santo Domingo</wicri:regionArea><wicri:noRegion>Santo Domingo</wicri:noRegion></affiliation></author><author><name sortKey="Farias, Hugo" sort="Farias, Hugo" uniqKey="Farias H" first="Hugo" last="Farías">Hugo Farías</name><affiliation><nlm:aff id="aff005"><addr-line>United Nations World Food Programme - Regional Bureau for Latin American and the Caribbean, Panamá, Rep. de Panama</addr-line></nlm:aff><wicri:noCountry code="subfield">Rep. de Panama</wicri:noCountry></affiliation></author><author><name sortKey="Palar, Kartika" sort="Palar, Kartika" uniqKey="Palar K" first="Kartika" last="Palar">Kartika Palar</name><affiliation wicri:level="2"><nlm:aff id="aff006"><addr-line>Division of HIV, ID and Global Medicine, School of Medicine, University of California - San Francisco, San Francisco, California, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of HIV, ID and Global Medicine, School of Medicine, University of California - San Francisco, San Francisco, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28742870</idno><idno type="pmc">5526502</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526502</idno><idno type="RBID">PMC:5526502</idno><idno type="doi">10.1371/journal.pone.0181568</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">002959</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002959</idno><idno type="wicri:Area/Pmc/Curation">002958</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002958</idno><idno type="wicri:Area/Pmc/Checkpoint">000218</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000218</idno><idno type="wicri:Area/Ncbi/Merge">004465</idno><idno type="wicri:Area/Ncbi/Curation">004465</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Factors contributing to food insecurity among women living with HIV in the Dominican Republic: A qualitative study</title><author><name sortKey="Derose, Kathryn P" sort="Derose, Kathryn P" uniqKey="Derose K" first="Kathryn P." last="Derose">Kathryn P. Derose</name><affiliation wicri:level="2"><nlm:aff id="aff001"><addr-line>Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Payan, Denise D" sort="Payan, Denise D" uniqKey="Payan D" first="Denise D." last="Payán">Denise D. Payán</name><affiliation wicri:level="2"><nlm:aff id="aff001"><addr-line>Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff002"><addr-line>Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Fulcar, Maria Altagracia" sort="Fulcar, Maria Altagracia" uniqKey="Fulcar M" first="María Altagracia" last="Fulcar">María Altagracia Fulcar</name><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>United Nations World Food Programme, Dominican Republic Country Office, Santo Domingo, Dominican Republic</addr-line></nlm:aff><country xml:lang="fr">République dominicaine</country><wicri:regionArea>United Nations World Food Programme, Dominican Republic Country Office, Santo Domingo</wicri:regionArea><wicri:noRegion>Santo Domingo</wicri:noRegion></affiliation></author><author><name sortKey="Terrero, Sergio" sort="Terrero, Sergio" uniqKey="Terrero S" first="Sergio" last="Terrero">Sergio Terrero</name><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>United Nations World Food Programme, Dominican Republic Country Office, Santo Domingo, Dominican Republic</addr-line></nlm:aff><country xml:lang="fr">République dominicaine</country><wicri:regionArea>United Nations World Food Programme, Dominican Republic Country Office, Santo Domingo</wicri:regionArea><wicri:noRegion>Santo Domingo</wicri:noRegion></affiliation></author><author><name sortKey="Acevedo, Ram N" sort="Acevedo, Ram N" uniqKey="Acevedo R" first="Ram N" last="Acevedo">Ram N Acevedo</name><affiliation wicri:level="1"><nlm:aff id="aff004"><addr-line>Consejo Nacional de VIH/SIDA (CONAVIHSIDA), Santo Domingo, Dominican Republic</addr-line></nlm:aff><country xml:lang="fr">République dominicaine</country><wicri:regionArea>Consejo Nacional de VIH/SIDA (CONAVIHSIDA), Santo Domingo</wicri:regionArea><wicri:noRegion>Santo Domingo</wicri:noRegion></affiliation></author><author><name sortKey="Farias, Hugo" sort="Farias, Hugo" uniqKey="Farias H" first="Hugo" last="Farías">Hugo Farías</name><affiliation><nlm:aff id="aff005"><addr-line>United Nations World Food Programme - Regional Bureau for Latin American and the Caribbean, Panamá, Rep. de Panama</addr-line></nlm:aff><wicri:noCountry code="subfield">Rep. de Panama</wicri:noCountry></affiliation></author><author><name sortKey="Palar, Kartika" sort="Palar, Kartika" uniqKey="Palar K" first="Kartika" last="Palar">Kartika Palar</name><affiliation wicri:level="2"><nlm:aff id="aff006"><addr-line>Division of HIV, ID and Global Medicine, School of Medicine, University of California - San Francisco, San Francisco, California, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of HIV, ID and Global Medicine, School of Medicine, University of California - San Francisco, San Francisco, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title><p>Food insecurity contributes to poor health outcomes among people living with HIV. In Latin America and the Caribbean, structural factors such as poverty, stigma, and inequality disproportionately affect women and may fuel both the HIV epidemic and food insecurity.</p></sec><sec id="sec002"><title>Methods</title><p>We examined factors contributing to food insecurity among women living with HIV (WLHIV) in the Dominican Republic (DR). Data collection included in-depth, semi-structured interviews in 2013 with 30 WLHIV with indications of food insecurity who resided in urban or peri-urban areas and were recruited from local HIV clinics. In-person interviews were conducted in Spanish. Transcripts were coded using content analysis methods and an inductive approach to identify principal and emergent themes.</p></sec><sec id="sec003"><title>Results</title><p>Respondents identified economic instability as the primary driver of food insecurity, precipitated by enacted stigma in the labor and social domains. Women described experiences of HIV-related labor discrimination in formal and informal sectors. Women commonly reported illegal HIV testing by employers, and subsequent dismissal if HIV-positive, especially in tourism and free trade zones. Enacted stigma in the social domain manifested as gossip and rejection by family, friends, and neighbors and physical, verbal, and sexual abuse by intimate partners, distancing women from sources of economic and food support. These experiences with discrimination and abuse contributed to internalized stigma among respondents who, as a result, were fearful and hesitant to disclose their HIV status; some participants reported leaving spouses and/or families, resulting in further isolation from economic resources, food and other support. A minority of participants described social support by friends, spouses, families and support groups, which helped to ameliorate food insecurity and emotional distress.</p></sec><sec id="sec004"><title>Conclusions</title><p>Addressing food insecurity among WLHIV requires policy and programmatic interventions to enforce existing laws designed to protect the rights of people living with HIV, reduce HIV-related stigma, and improve gender equality.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Anderson, S" uniqKey="Anderson S">S Anderson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ivers, Lc" uniqKey="Ivers L">LC Ivers</name></author><author><name sortKey="Cullen, Ka" uniqKey="Cullen K">KA Cullen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Loevinsohn, M" uniqKey="Loevinsohn M">M Loevinsohn</name></author><author><name sortKey="Gillespie, S" 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Miller</name></author><author><name sortKey="Bangsberg, Dr" uniqKey="Bangsberg D">DR Bangsberg</name></author><author><name sortKey="Tuller, Dm" uniqKey="Tuller D">DM Tuller</name></author><author><name sortKey="Senkungu, J" uniqKey="Senkungu J">J Senkungu</name></author><author><name sortKey="Kawuma, A" uniqKey="Kawuma A">A Kawuma</name></author><author><name sortKey="Frongillo, Ea" uniqKey="Frongillo E">EA Frongillo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Paudel, V" uniqKey="Paudel V">V Paudel</name></author><author><name sortKey="Baral, Kp" uniqKey="Baral K">KP Baral</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Singer, Aw" uniqKey="Singer A">AW Singer</name></author><author><name sortKey="Weiser, Sd" uniqKey="Weiser S">SD Weiser</name></author><author><name sortKey="Mccoy, Si" uniqKey="Mccoy S">SI McCoy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Aberman, Nl" 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