BACKGROUND: Food insecurity and alcohol consumption are prevalent and have health consequences among people living with HIV infection or AIDS (PLWHA). Food insecurity could be associated with unhealthy alcohol use via hunger or other mechanisms. However, it is not well-known whether the two (food insecurity and unhealthy alcohol use) are associated. OBJECTIVE: The objective of this study was to determine an association between food insecurity and unhealthy alcohol use in people with HIV/AIDS and substance use disorder. It was hypothesized that food insecurity, compared to food security, would be associated with unhealthy alcohol use in this population. METHODS: This study is a cross sectional analysis of data collected from adults with HIV infection and current alcohol or other drug dependence or ever injection drug use, who were participants in a cohort study known as the Boston Alcohol Research Collaboration on HIV/AIDS (ARCH) study. Food insecurity, the independent variable, was assessed using the Household Food Insecurity Assessment Scale (HFIAS) questionnaire (defined as a dichotomized measure of food insecure (mild, moderate, severe) versus food secure). Unhealthy alcohol use, the dependent variable, was assessed using the Alcohol Use Disorder Identification Test – Consumption (AUDIT-C) questionnaire (defined as a score greater than 3 in males and a score greater than 2 in females). Participants were assessed at two time points 12 months apart. In generalized estimating equations, we studied the association between food insecurity and unhealthy alcohol use at each time point. Covariates adjusted for included age, sex, race, HIV viral load, CD4 cell count, physical health, mental health, number of people the individual spent time with who were heavy or problem drinkers, homelessness, if the participant had someone to turn to in a time of need, and drug dependence. RESULTS: Of the 250 participants enrolled in the Boston ARCH cohort, 233 completed the HFIAS and the AUDIT-C questionnaires at either or both time points. There were 100 participants who completed the questionnaires at time point 1 only, 67 at time point 2 only, and 66 at both time points resulting in a total of 299 data points. The mean age of our sample was in the 6th decade and the majority were Black/African American and identified as male. The majority (80%) had an HIV viral load under 200 and over half of the sample also had a CD4 cell count greater than or equal to 500. Unhealthy alcohol use was common (40%) and 44% had food insecurity. In unadjusted analysis, food insecurity was associated (p=0.08) with unhealthy alcohol use [OR=1.58 (CI 95%: 0.95, 2.62)]; however, this association disappeared in adjusted analysis [OR: 1.06 (CI 95%: 0.59, 1.87), p=0.85]. / 2018-07-11T00:00:00Z

Thesis (Ph.D. (Agricultural Economics )) -- University of Limpopo, 2021 / Regardless of the strategies adopted globally and nationwide to fight food insecurity within communities, particularly in the rural context, poverty becomes a major constituent which translates to most rural households experiencing food insecurity shocks. Given the high unemployment rate in South Africa which triggers several household’s vulnerability to food insecurity, the country has diverse natural resources which include indigenous plants such as Indigenous Leafy Vegetables (ILVs), which can be used as food and for business purposes by its residents. Irrespective of the diversity of ILVs in South Africa, there is a significant decline in the production and consumption of ILVs particularly in rural areas where these vegetables are mostly available. In addition, production and consumption of ILVs may not only address food insecurity but these vegetables may benefit households through the income obtained from their sales. The income generated from sales of ILVs may therefore assist towards improving and sustaining rural livelihood needs. Given this background information, the study aimed at assessing ILV production for income generation and food security among rural households in the Eastern Cape Province (ECP) of South Africa. The study was conducted within the three district municipalities of the ECP which were selected because statistics report these districts to be the most affected areas by poverty within the province. These districts are OR Tambo District Municipality (ORTDM), Alfred Nzo District Municipality (ANDM) and Joe Gqabi District Municipality (JGDM). Multistage and proportional random sampling procedures were employed to select households which could participate in the study. Thus, 407 households within these three (3) districts municipalities were used for the purposes of the study. The study also included interviewing role players within the ILV production value chain, thus a snowball sampling procedure was used to select role players. Sixteen hawkers and three input suppliers were interviewed from the three district municipalities. In addition, from the 407 households that were interviewed, 260 households from the three district municipalities reported to be producers of ILVs. A structured questionnaire was therefore used to collect pertaining data allied in achieving the aim of the study. The collected data was captured using Excel 2016, after data cleaning, it was then exported to Statistical Package for Social Sciences (SPSS) version 25 for analysis. Numerous analytical models were used from SPSS 25. For instance, to identify and describe socio-economic characteristics of households, to assess the most produced ILVs from the study areas and to identify role players within the ILV production value chain, descriptive statistics in a form of means, percentages, frequencies, and standard deviation was used. To determine factors which influence production of ILVs, a Binary Logistic Regression Model was used. A Multinomial Logistic Regression model was used to determine factors which influence different uses of ILVs by households and to determine factors influencing food security status among households. A gross margin analysis was used to estimate viability from each ILV produced, harvested and sold, while Household Food Insecurity Access Scale (HFIAS) was used to measure food security status among households. Lastly, a correlation matrix was also used to determine the relationship between the role players and their functions among the ILV production value chain. Based on the results, the study therefore concluded that, from the three district municipalities used in the study, there are various ILVs growing naturally and produced. The production of ILVs from these municipalities is habituated by socio economic characteristics of households, wherein households use ILVs for various purposes which include these vegetables as source of food, medicine and livestock feed. The use of ILVs among households is influenced by socio-economic characteristics and seasonal availability of ILVs in ORTDM, while in ANDM and JGDM, the use of ILVs by households is conditioned by socio-economic characteristics of households, knowledge/ awareness related to nutrition and health benefits of ILVs and seasonal production of ILVs. Furthermore, this research concludes that, ILVs have a potential of diversifying diets and addressing food insecurity problems within rural parts of the three districts. Given the positive gross margins from the three districts, production and selling of ILVs has a potential to contribute to rural household income. Lastly, the study concludes that, the ILV production value chain system lacks governmental support in the form of institutional engagement since there is no evidence of extension officer support from these three district municipalities concerning ILVs production. To this end, the study recommends that, policy makers should further establish inclusion of ILVs in both farming and food systems. Also, government and related institutions which focus on sustainable rural development must intervene in promoting production of ILVs particularly within rural contexts since production of these vegetables may alleviate poverty through job creation, addressing food insecurity and income generation. Thus, a successful intervention of government and policy makers in ILV production would have a potential of translating to sustainable rural livelihoods / National Research Foundation (NRF)