Moderate and severe household food insecurity in families of people living with HIV/Aids: scale validation and associated factors

Abstract Vulnerable population groups, including people living with HIV/Aids (PLHA), may have a high prevalence of food insecurity (FI). A cross-sectional study evaluated the internal validity of the Brazilian Food Insecurity Scale (Escala Brasileira de Insegurança Alimentar – EBIA) and measured the prevalence of FI in a sample of 796 PLHA in João Pessoa, Paraíba State (PB). The validation was performed using a Rasch analysis. The association of FI with sociodemographic and clinical characteristics was assessed using the chi-square test. Associated variables were included in a Poisson multiple regression model. The EBIA was valid for PLHA with fit values within the expected limits and item severity conforming to the theoretical model. The EBIA identified 66.5% of PLHA with FI in the sample (30.8% mild FI, 18.1% moderate FI and 17.6% severe FI). Moderate FI and severe FI were associated with an age younger than 43 years (prevalence ratio (PR) = 1.49; 95% confidence interval (CI): 1.14-1.86), primary education (PR=1.64; 95% CI: 1.24-2.17), income per capita lower than ½ minimum wage (MW) (PR=1.83; 95% CI: 1.37-2.44), lack of occupation (PR=1.59; 95% CI: 1.16-2.19) and adult-only households with a female reference person (PR=2.19; 95% CI: 1.45-3.31). The PLHA in this study had a high prevalence of FI, worsening their living conditions and potentially exacerbating their health problems.

摘要：脆弱人群，包括人类免疫缺陷病毒/获得性免疫缺陷综合征感染者（People Living with HIV/AIDS, PLHA），往往具有较高的食物不安全（Food Insecurity, FI）患病率。本项横断面研究评估了巴西食物不安全量表（Escala Brasileira de Insegurança Alimentar – EBIA）的内部效度，并在帕拉伊巴州若昂佩索阿市的796名PLHA样本中测量了食物不安全的患病率。效度分析采用拉什分析（Rasch analysis）；食物不安全与社会人口学及临床特征的关联采用卡方检验（chi-square test）进行评估，并将关联变量纳入泊松多重回归（Poisson multiple regression）模型。结果显示，EBIA的拟合值处于预期范围内，条目严重程度符合理论模型，适用于PLHA人群。该量表检出样本中66.5%的PLHA存在食物不安全，其中轻度食物不安全占30.8%、中度占18.1%、重度占17.6%。中度及重度食物不安全与以下因素相关：年龄小于43岁（患病率比（prevalence ratio, PR）=1.49；95%置信区间（confidence interval, CI）：1.14~1.86）、初等教育学历（PR=1.64；95%CI：1.24~2.17）、人均收入低于最低工资（minimum wage, MW）的1/2（PR=1.83；95%CI：1.37~2.44）、无业状态（PR=1.59；95%CI：1.16~2.19）以及仅成人居住且以女性为户主的家庭（PR=2.19；95%CI：1.45~3.31）。本研究中的PLHA人群食物不安全患病率较高，这将加剧其生活困境，并可能加重其健康问题。