‘When you take pills you must eat’: Food (in)security and ART adherence among older people living with HIV

ABSTRACT

South Africa has increasing numbers of persons living with HIV on antiretroviral treatment (ART). There is evidence for a relationship between food, food security and HIV. Despite increasing rates of people older than 50 living with HIV coinciding with greater levels of co-morbidity, the existing research is largely limited to those aged 15–49 years. In this paper, we therefore explore how older people living with HIV (OPLWH) in two urban communities within South Africa negotiate and ensure they have sufficient access to food and how food insecurity may affect their retention in care and ART adherence. This study used exploratory qualitative semi-structured in-depth interviews with 23 OPLWH to collect data in isiXhosa. Data were analysed using thematic content analysis. Factors at the community, household and individual levels influence (a) access to sufficient and quality food, and (b) beliefs about ART and food based on (mis)understandings of messaging from health care providers. The results demonstrate the need to explore further and clarify the nutritional guidelines that OPLWH receive from providers to ensure this does not result in reduced adherence or retention in care. They also demonstrate the role that social welfare and family or kin obligations plays in ensuring the food security of OPLWH.

KEYWORDS:

• Older people
• food security
• ART
• adherence
• South Africa

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Lucia Knight http://orcid.org/0000-0001-9938-6887

Enid Schatz http://orcid.org/0000-0003-3963-2745

Kaleea R. Lewis http://orcid.org/0000-0002-9885-4826

Ferdinand C. Mukumbang http://orcid.org/0000-0003-1441-2172

Notes

1 Food security is defined broadly as the physical, social and economic access to sufficient food meeting people’s dietary needs and food preferences (FAO et al., 2018).

Additional information

Funding

This research was funded by the University of Missouri South Africa Exchange Program, which is administered in collaboration with the University of the Western Cape South Africa and with financial support from the Department of Science and Technology/National Research Foundation (DST/NRF) Centre of Excellence in Food Security [Project 170405]. The funders were not involved in any of the research processes.