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PLoS One. 2019 Mar 6;14(3):e0213365. doi: 10.1371/journal.pone.0213365. eCollection 2019.

Food insecurity and violence in a prospective cohort of women at risk for or living with HIV in the U.S.

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Center for AIDS Prevention Studies, University of California, San Francisco (UCSF), CA, United States of America.
Department of Medicine, Stroger Hospital, Chicago, IL, United States of America.
Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, United States of America.
Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America.
Department of Community Health Sciences, State University of New York Downstate Medical Center, School of Public Health, Brooklyn, NY, United States of America.
Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States of America.
School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
Department of Family Medicine, Georgetown University Medical Center, Washington, DC, United States of America.
School of Medicine, Emory University, Atlanta, GA, and Grady Healthcare System, Atlanta, GA, United States of America.
Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America.
School of Nursing, School of Public Health and School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America.
Dept. of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States of America.
Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America.
Department of Medicine, UCSF and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA, United States of America.



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.

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

The authors have declared that no competing interests exists.

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