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Tracy Makuvire, MD, MPH




Clinical Fellow




Internal Medicine Resident




*Tracy Makuvire, *Tiffany Lemon, *Elzette Rousseau, *Siyaxolisa Sindelo, *Robin Julies, *Sheri Weiser, *Linda-Gail Bekker, and *Ingrid Katz

Food Insecurity on Trust in Providers Among Adolescents and Young Adults Newly Diagnosed with HIV

I am currently an internal medicine resident, who found her passion for research in health equity in southern Africa. My mentor Dr Katz, had mentored me since medical school. Even when my clinical interests changed to cardiology, she still supports my research projects in southern Africa. I am particularly excited to submit our newest project focusing on adolescents newly diagnosed with HIV and the impact of food insecurity on their relationship of trust with providers and the health care system. Trust is a key mediator for treatment initiation and adherence, hence it’s crucial to address high levels of food insecurity.


The dual epidemics of food insecurity and HIV/AIDS are a growing concern in South Africa. Rates of undernourishment are increasing among people living with HIV (PLWH). We wanted to explore the association between food insecurity and trust in providers among adolescents and young adults (AYA) living with HIV.


We analyzed baseline data from Standing Tall, a prospective cohort study of newly diagnosed HIV-positive AYA in South Africa from 2018 – 2019. We performed a cross-sectional analysis of food insecurity, defined using the Household Food Insecurity Access Survey (HFIAS).


Overall, 100 subjects were included in the analysis. The mean age was 21 years old. At baseline, the prevalence of food insecurity was 63%. In adjusted analyses, the odds of complete trust in the healthcare system were significantly lower in those with more food insecurity than those with less food insecurity (aOR: 0.28, 95% CI: 0.09, 0.97). The adjusted odds ratio for complete trust in providers was similar (aOR: 0.45, 95% CI: 0.15, 1.39).


The majority of AYA diagnosed with HIV report high levels of food insecurity that are associated with lower trust in the healthcare system. Every health encounter with young PLWH should incorporate screening for food insecurity to increase early identification and referral to appropriate resources.