Factors contributing to food insecurity among women living with HIV in the Dominican Republic: A qualitative study
Identifieur interne : 004465 ( Ncbi/Merge ); 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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<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></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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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, CA USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28742870</article-id><article-id pub-id-type="pmc">5526502</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0181568</article-id><article-id pub-id-type="publisher-id">PONE-D-16-49382</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Microbiology</subject><subj-group><subject>Medical Microbiology</subject><subj-group><subject>Microbial Pathogens</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Immunodeficiency Viruses</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Pathology and Laboratory Medicine</subject><subj-group><subject>Pathogens</subject><subj-group><subject>Microbial Pathogens</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Immunodeficiency Viruses</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Viruses</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Immunodeficiency Viruses</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Viruses</subject><subj-group><subject>Immunodeficiency Viruses</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and life sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Viruses</subject><subj-group><subject>RNA viruses</subject><subj-group><subject>Retroviruses</subject><subj-group><subject>Lentivirus</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Microbiology</subject><subj-group><subject>Medical Microbiology</subject><subj-group><subject>Microbial Pathogens</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Retroviruses</subject><subj-group><subject>Lentivirus</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Pathology and Laboratory Medicine</subject><subj-group><subject>Pathogens</subject><subj-group><subject>Microbial Pathogens</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Retroviruses</subject><subj-group><subject>Lentivirus</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Viruses</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Retroviruses</subject><subj-group><subject>Lentivirus</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Social Sciences</subject><subj-group><subject>Sociology</subject><subj-group><subject>Human Families</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Social Sciences</subject><subj-group><subject>Economics</subject><subj-group><subject>Labor Economics</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Social Sciences</subject><subj-group><subject>Economics</subject></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Social Sciences</subject><subj-group><subject>Economics</subject><subj-group><subject>Labor Economics</subject><subj-group><subject>Employment</subject><subj-group><subject>Jobs</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Social Sciences</subject><subj-group><subject>Economics</subject><subj-group><subject>Health Economics</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Health Care</subject><subj-group><subject>Health Economics</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject><subj-group><subject>Population Groupings</subject><subj-group><subject>Families</subject><subj-group><subject>Mothers</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Computer and Information Sciences</subject><subj-group><subject>Network Analysis</subject><subj-group><subject>Social Networks</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Social Sciences</subject><subj-group><subject>Sociology</subject><subj-group><subject>Social Networks</subject></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Factors contributing to food insecurity among women living with HIV in the Dominican Republic: A qualitative study</article-title><alt-title alt-title-type="running-head">Factors contributing to food insecurity among women with HIV in the Dominican Republic</alt-title></title-group><contrib-group><contrib contrib-type="author"><contrib-id authenticated="true" contrib-id-type="orcid">http://orcid.org/0000-0001-7742-6024</contrib-id><name><surname>Derose</surname><given-names>Kathryn P.</given-names></name><role content-type="http://credit.casrai.org/">Conceptualization</role><role content-type="http://credit.casrai.org/">Formal analysis</role><role content-type="http://credit.casrai.org/">Funding acquisition</role><role content-type="http://credit.casrai.org/">Methodology</role><role content-type="http://credit.casrai.org/">Supervision</role><role content-type="http://credit.casrai.org/">Visualization</role><role content-type="http://credit.casrai.org/">Writing – original draft</role><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="corresp" rid="cor001">*</xref></contrib><contrib contrib-type="author"><name><surname>Payán</surname><given-names>Denise D.</given-names></name><role content-type="http://credit.casrai.org/">Conceptualization</role><role content-type="http://credit.casrai.org/">Formal analysis</role><role content-type="http://credit.casrai.org/">Visualization</role><role content-type="http://credit.casrai.org/">Writing – original draft</role><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="aff" rid="aff002"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Fulcar</surname><given-names>María Altagracia</given-names></name><role content-type="http://credit.casrai.org/">Investigation</role><role content-type="http://credit.casrai.org/">Methodology</role><role content-type="http://credit.casrai.org/">Project administration</role><role content-type="http://credit.casrai.org/">Resources</role><role content-type="http://credit.casrai.org/">Supervision</role><role content-type="http://credit.casrai.org/">Writing – review & editing</role><xref ref-type="aff" rid="aff003"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Terrero</surname><given-names>Sergio</given-names></name><role content-type="http://credit.casrai.org/">Data curation</role><role content-type="http://credit.casrai.org/">Formal analysis</role><role content-type="http://credit.casrai.org/">Validation</role><role content-type="http://credit.casrai.org/">Writing – review & editing</role><xref ref-type="aff" rid="aff003"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Acevedo</surname><given-names>Ramón</given-names></name><role content-type="http://credit.casrai.org/">Writing – review & editing</role><xref ref-type="aff" rid="aff004"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Farías</surname><given-names>Hugo</given-names></name><role content-type="http://credit.casrai.org/">Funding acquisition</role><role content-type="http://credit.casrai.org/">Methodology</role><role content-type="http://credit.casrai.org/">Project administration</role><role content-type="http://credit.casrai.org/">Resources</role><role content-type="http://credit.casrai.org/">Supervision</role><role content-type="http://credit.casrai.org/">Writing – review & editing</role><xref ref-type="aff" rid="aff005"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Palar</surname><given-names>Kartika</given-names></name><role content-type="http://credit.casrai.org/">Conceptualization</role><role content-type="http://credit.casrai.org/">Data curation</role><role content-type="http://credit.casrai.org/">Formal analysis</role><role content-type="http://credit.casrai.org/">Funding acquisition</role><role content-type="http://credit.casrai.org/">Investigation</role><role content-type="http://credit.casrai.org/">Methodology</role><role content-type="http://credit.casrai.org/">Supervision</role><role content-type="http://credit.casrai.org/">Validation</role><role content-type="http://credit.casrai.org/">Writing – review & editing</role><xref ref-type="aff" rid="aff006"><sup>6</sup></xref></contrib></contrib-group><aff id="aff001"><label>1</label><addr-line>Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California, United States of America</addr-line></aff><aff id="aff002"><label>2</label><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></aff><aff id="aff003"><label>3</label><addr-line>United Nations World Food Programme, Dominican Republic Country Office, Santo Domingo, Dominican Republic</addr-line></aff><aff id="aff004"><label>4</label><addr-line>Consejo Nacional de VIH/SIDA (CONAVIHSIDA), Santo Domingo, Dominican Republic</addr-line></aff><aff id="aff005"><label>5</label><addr-line>United Nations World Food Programme - Regional Bureau for Latin American and the Caribbean, Panamá, Rep. de Panama</addr-line></aff><aff id="aff006"><label>6</label><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></aff><contrib-group><contrib contrib-type="editor"><name><surname>Renzaho</surname><given-names>Andre M. N.</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>Western Sydney University, AUSTRALIA</addr-line></aff><author-notes><fn fn-type="COI-statement" id="coi001"><p><bold>Competing Interests: </bold>The authors declare that no competing interests exist.</p></fn><corresp id="cor001">* E-mail: <email>derose@rand.org</email></corresp></author-notes><pub-date pub-type="epub"><day>25</day><month>7</month><year>2017</year></pub-date><pub-date pub-type="collection"><year>2017</year></pub-date><volume>12</volume><issue>7</issue><elocation-id>e0181568</elocation-id><history><date date-type="received"><day>14</day><month>12</month><year>2016</year></date><date date-type="accepted"><day>24</day><month>6</month><year>2017</year></date></history><permissions><copyright-statement>© 2017 Derose et al</copyright-statement><copyright-year>2017</copyright-year><copyright-holder>Derose et al</copyright-holder><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><self-uri content-type="pdf" xlink:href="pone.0181568.pdf"></self-uri><abstract><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></abstract><funding-group><award-group id="award001"><funding-source><institution>World Food Programme</institution></funding-source><principal-award-recipient><contrib-id authenticated="true" contrib-id-type="orcid">http://orcid.org/0000-0001-7742-6024</contrib-id><name><surname>Derose</surname><given-names>Kathryn P.</given-names></name></principal-award-recipient></award-group><award-group id="award002"><funding-source><institution>World Food Programme</institution></funding-source><principal-award-recipient><name><surname>Palar</surname><given-names>Kartika</given-names></name></principal-award-recipient></award-group><award-group id="award003"><funding-source><institution-wrap><institution-id institution-id-type="funder-id">http://dx.doi.org/10.13039/100000025</institution-id><institution>National Institute of Mental Health</institution></institution-wrap></funding-source><award-id>R34MH110325</award-id><principal-award-recipient><contrib-id authenticated="true" contrib-id-type="orcid">http://orcid.org/0000-0001-7742-6024</contrib-id><name><surname>Derose</surname><given-names>Kathryn P.</given-names></name></principal-award-recipient></award-group><award-group id="award004"><funding-source><institution-wrap><institution-id institution-id-type="funder-id">http://dx.doi.org/10.13039/100000133</institution-id><institution>Agency for Healthcare Research and Quality</institution></institution-wrap></funding-source><award-id>T32HS00046</award-id><principal-award-recipient><name><surname>Payán</surname><given-names>Denise D.</given-names></name></principal-award-recipient></award-group><award-group id="award005"><funding-source><institution-wrap><institution-id institution-id-type="funder-id">http://dx.doi.org/10.13039/100000133</institution-id><institution>Agency for Healthcare Research and Quality</institution></institution-wrap></funding-source><award-id>T32HS00046</award-id><principal-award-recipient><name><surname>Palar</surname><given-names>Kartika</given-names></name></principal-award-recipient></award-group><award-group id="award006"><funding-source><institution-wrap><institution-id institution-id-type="funder-id">http://dx.doi.org/10.13039/100000062</institution-id><institution>National Institute of Diabetes and Digestive and Kidney Diseases</institution></institution-wrap></funding-source><award-id>K01DK107335</award-id><principal-award-recipient><name><surname>Palar</surname><given-names>Kartika</given-names></name></principal-award-recipient></award-group><funding-statement>We acknowledge financial support from the World Food Programme (WFP) for local data collection. For analysis and manuscript preparation, we acknowledge the following institutions for partial or full salary support of various co-authors: the National Institute of Mental Health or NIMH (grant number R34MH110325, Dr. Derose); the Agency for Healthcare Research and Quality or AHRQ (grant number T32HS00046, Dr. Palar, Dr. Payán); the National Institute of Diabetes and Digestive and Kidney Diseases or NIDDK (grant number K01 DK107335, Dr. Palar). The contents of the manuscript are solely the responsibility of the authors and do not represent the official views of WFP, NIMH, AHRQ, or NIDDK. The funders provided support in the form of salaries for authors [NIMH: KPD; AHRQ: DDP, KP; NIDDK: KP; WFP: MAF, ST, HF], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.</funding-statement></funding-group><counts><fig-count count="0"></fig-count><table-count count="1"></table-count><page-count count="19"></page-count></counts><custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name><meta-value>The data upon which this manuscript is based are in-depth interview transcripts from a small sample of marginalized and stigmatized HIV+ women and contain highly sensitive data, including personal information on sexual behavior and intimate partner violence. As whole transcripts, these data are identifiable via inference, and thus, sharing them would violate the promise of confidentiality made to participants during informed consent. Excerpts of the transcripts relevant to the study, beyond what is already provided in the article as illustrative quotations, are available to qualified researchers upon request to the first author: Dr. Kathryn Derose (<email>derose@rand.org</email>). Queries regarding data access can be addressed by the RAND Human Subjects Protection Committee (HSPC) by contacting Sandy Berry, HSPC Chair (<email>berry@rand.org</email>).</meta-value></custom-meta></custom-meta-group></article-meta><notes><title>Data Availability</title><p>The data upon which this manuscript is based are in-depth interview transcripts from a small sample of marginalized and stigmatized HIV+ women and contain highly sensitive data, including personal information on sexual behavior and intimate partner violence. As whole transcripts, these data are identifiable via inference, and thus, sharing them would violate the promise of confidentiality made to participants during informed consent. Excerpts of the transcripts relevant to the study, beyond what is already provided in the article as illustrative quotations, are available to qualified researchers upon request to the first author: Dr. Kathryn Derose (<email>derose@rand.org</email>). Queries regarding data access can be addressed by the RAND Human Subjects Protection Committee (HSPC) by contacting Sandy Berry, HSPC Chair (<email>berry@rand.org</email>).</p></notes></front></pmc><affiliations><list><country><li>République dominicaine</li><li>États-Unis</li></country><region><li>Californie</li></region></list><tree><noCountry><name sortKey="Farias, Hugo" sort="Farias, Hugo" uniqKey="Farias H" first="Hugo" last="Farías">Hugo Farías</name></noCountry><country name="États-Unis"><region name="Californie"><name sortKey="Derose, Kathryn P" sort="Derose, Kathryn P" uniqKey="Derose K" first="Kathryn P." last="Derose">Kathryn P. Derose</name></region><name sortKey="Palar, Kartika" sort="Palar, Kartika" uniqKey="Palar K" first="Kartika" last="Palar">Kartika Palar</name><name sortKey="Payan, Denise D" sort="Payan, Denise D" uniqKey="Payan D" first="Denise D." last="Payán">Denise D. Payán</name><name sortKey="Payan, Denise D" sort="Payan, Denise D" uniqKey="Payan D" first="Denise D." last="Payán">Denise D. Payán</name></country><country name="République dominicaine"><noRegion><name sortKey="Fulcar, Maria Altagracia" sort="Fulcar, Maria Altagracia" uniqKey="Fulcar M" first="María Altagracia" last="Fulcar">María Altagracia Fulcar</name></noRegion><name sortKey="Acevedo, Ram N" sort="Acevedo, Ram N" uniqKey="Acevedo R" first="Ram N" last="Acevedo">Ram N Acevedo</name><name sortKey="Terrero, Sergio" sort="Terrero, Sergio" uniqKey="Terrero S" first="Sergio" last="Terrero">Sergio Terrero</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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