Skip to main content

Advertisement

Log in

Food Insecurity Is Associated with Greater Acute Care Utilization among HIV-Infected Homeless and Marginally Housed Individuals in San Francisco

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

Food insecurity, or the uncertain availability of nutritionally adequate, safe foods, has been associated with poor HIV outcomes. There are few data on the extent to which food insecurity impacts patterns of health-care utilization among HIV-infected individuals.

Objective

We examined whether food insecurity was associated with hospitalizations, Emergency Department (ED) visits, and non-ED outpatient visits.

Methods

HIV-infected, homeless and marginally housed individuals participating in the San Francisco Research on Access to Care in the Homeless (REACH) cohort underwent quarterly structured interviews and blood draws. We measured food insecurity with the validated Household Food Insecurity Access Scale, and categorized participants as food secure, mild/moderately food insecure, and severely food insecure. Primary outcomes were: (1) any hospitalizations, (2) any ED visits, and (3) any non-ED outpatient visits. Generalized estimating equations were used to estimate model parameters, adjusting for socio-demographic (age, sex, ethnicity, education, income, housing status, health insurance) and clinical variables (CD4 nadir, time on antiretroviral therapy, depression, and illicit drug use).

Results

Beginning in November 2007, 347 persons were followed for a median of 2 years. Fifty-six percent of participants were food insecure at enrollment. Compared with food-secure persons, those with severe food insecurity had increased odds of hospitalizations [adjusted odds ratio (AOR) = 2.16, 95 % confidence interval (CI) = 1.50–3.09] and ED visits (AOR = 1.71, 95 % CI = 1.06–2.30). While the odds of an outpatient visit were 41 % higher for severely food insecure individuals, the effect was not statistically significant (AOR = 1.41, 95 % CI = 0.99–2.01). Mild/moderate food insecurity was also associated with increased hospitalizations (AOR = 1.56, 95 % CI = 1.06–2.30), ED visits (AOR = 1.57, 95 % CI = 1.22–2.03), and outpatient visits (AOR = 1.68, 95 % CI = 1.20–2.17).

Conclusions

Food insecurity is associated with increased health services utilization among homeless and marginally housed HIV-infected individuals in San Francisco. Increased ED visits and hospitalizations are not related to fewer ambulatory care visits among food-insecure individuals. Addressing food insecurity should be a critical component of HIV treatment programs and may reduce reliance on acute care utilization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hogg RS, O'Shaughnessy MV, Gataric N, et al. Decline in deaths from AIDS due to new antiretrovirals. Lancet. 1997;349(9061):1294.

    Article  PubMed  CAS  Google Scholar 

  2. Hogg RS, Heath KV, Yip B, et al. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA. 1998;279(6):450–4.

    Article  PubMed  CAS  Google Scholar 

  3. Buchacz K, Baker RK, Moorman AC, et al. Rates of hospitalizations and associated diagnoses in a large multisite cohort of HIV patients in the United States, 1994–2005. AIDS. 2008;22(11):1345–54.

    Article  PubMed  Google Scholar 

  4. Hellinger FJ. The changing pattern of hospital care for persons living with HIV: 2000 through 2004. J Acquir Immune Defic Syndr. 2007;45(2):239–46.

    Article  PubMed  Google Scholar 

  5. Yehia BR, Fleishman JA, Hicks PL, Ridore M, Moore RD, Gebo KA. Inpatient health services utilization among HIV-infected adult patients in care 2002–2007. J Acquir Immune Defic Syndr. 2010;53(3):397–404.

    Article  PubMed  Google Scholar 

  6. Floris-Moore M, Lo Y, Klein RS, et al. Gender and hospitalization patterns among HIV-infected drug users before and after the availability of highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2003;34(3):331–7.

    Article  PubMed  Google Scholar 

  7. Fleishman JA, Gebo KA, Reilly ED, et al. Hospital and outpatient health services utilization among HIV-infected adults in care 2000–2002. Med Care. 2005;43(9 Suppl):III40–52.

    PubMed  Google Scholar 

  8. Gebo KA, Fleishman JA, Conviser R, et al. Racial and gender disparities in receipt of highly active antiretroviral therapy persist in a multistate sample of HIV patients in 2001. J Acquir Immune Defic Syndr. 2005;38(1):96–103.

    Article  PubMed  Google Scholar 

  9. Sohler NL, Li X, Cunningham CO. Gender disparities in HIV health care utilization among the severely disadvantaged: can we determine the reasons? AIDS Patient Care STDS. 2009;23(9):775–83.

    Article  PubMed  Google Scholar 

  10. Shapiro MF, Morton SC, McCaffrey DF, et al. Variations in the care of HIV-infected adults in the United States: results from the HIV cost and services utilization study. Jama. 1999;281(24):2305–15.

    Article  PubMed  CAS  Google Scholar 

  11. Losina E, Schackman BR, Sadownik SN, et al. Racial and sex disparities in life expectancy losses among HIV-infected persons in the united states: impact of risk behavior, late initiation, and early discontinuation of antiretroviral therapy. Clin Infect Dis. 2009;49(10):1570–8.

    Article  PubMed  Google Scholar 

  12. Meditz AL, MaWhinney S, Allshouse A, et al. Sex, race, and geographic region influence clinical outcomes following primary HIV-1 infection. J Infect Dis. 2011;203(4):442–51.

    Article  PubMed  Google Scholar 

  13. Nosyk B, Li X, Sun H, Anis AH. The effect of homelessness on hospitalisation among patients with HIV/AIDS. AIDS Care. 2007;19(4):546–53.

    Article  PubMed  CAS  Google Scholar 

  14. Riley ED, Neilands TB, Moore K, Cohen J, Bangsberg DR, Havlir D. Social, structural and behavioral determinants of overall health status in a cohort of homeless and unstably housed HIV-infected Men. PLoS One. 2012;7(4):e35207.

    Article  PubMed  CAS  Google Scholar 

  15. Normen L, Chan K, Braitstein P, et al. Food insecurity and hunger are prevalent among HIV-positive individuals in British Columbia, Canada. J Nutr. 2005;135(4):820–5.

    PubMed  CAS  Google Scholar 

  16. Rose D, Oliveira V. Nutrient intakes of individuals from food-insufficient households in the United States. Am J Public Health. 1997;87(12):1956–61.

    Article  PubMed  CAS  Google Scholar 

  17. Rose D. Economic determinants and dietary consequences of food insecurity in the United States. J Nutr. 1999;129(2 S Suppl):517S–20.

    PubMed  CAS  Google Scholar 

  18. Lee JS, Frongillo EA Jr. Nutritional and health consequences are associated with food insecurity among U.S. elderly persons. J Nutr. 2001;131(5):1503–9.

    PubMed  CAS  Google Scholar 

  19. Dixon LB, Winkleby MA, Radimer KL. Dietary intakes and serum nutrients differ between adults from food-insufficient and food-sufficient families: third national health and nutrition examination survey, 1988–1994. J Nutr. 2001;131(4):1232–46.

    PubMed  CAS  Google Scholar 

  20. Kirkpatrick SI, Tarasuk V. Food insecurity is associated with nutrient inadequacies among Canadian adults and adolescents. J Nutr. 2008;138(3):604–12.

    PubMed  CAS  Google Scholar 

  21. Campa A, Yang Z, Lai S, et al. HIV-related wasting in HIV-infected drug users in the era of highly active antiretroviral therapy. Clin Infect Dis. 2005;41(8):1179–85.

    Article  PubMed  Google Scholar 

  22. Weaver LJ, Hadley C. Moving beyond hunger and nutrition: a systematic review of the evidence linking food insecurity and mental health in developing countries. Ecol Food Nutr. 2009;48(4):263–84.

    Article  PubMed  Google Scholar 

  23. Maes KC, Hadley C, Tesfaye F, Shifferaw S. Food insecurity and mental health: Surprising trends among community health volunteers in Addis Ababa, Ethiopia during the 2008 food crisis. Soc Sci Med. Feb 12 2010.

  24. Kim K, Frongillo EA. Participation in food assistance programs modifies the relation of food insecurity with weight and depression in elders. J Nutr. 2007;137(4):1005–10.

    PubMed  CAS  Google Scholar 

  25. Heflin CM, Siefert K, Williams DR. Food insufficiency and women’s mental health: findings from a 3-year panel of welfare recipients. Soc Sci Med. 2005;61(9):1971–82.

    Article  PubMed  Google Scholar 

  26. Alaimo K, Olson CM, Frongillo EA. Family food insufficiency, but not low family income, is positively associated with dysthymia and suicide symptoms in adolescents. J Nutr. 2002;132(4):719–25.

    PubMed  CAS  Google Scholar 

  27. Dinour LM, Bergen D, Yeh MC. The food insecurity-obesity paradox: a review of the literature and the role food stamps may play. J Am Diet Assoc. 2007;107(11):1952–61.

    Article  PubMed  Google Scholar 

  28. Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low-income NHANES participants. J Nutr. 2010;140(2):304–10.

    Article  PubMed  CAS  Google Scholar 

  29. Seligman HK, Bindman AB, Vittinghoff E, Kanaya AM, Kushel MB. Food insecurity is associated with diabetes mellitus: results from the national health examination and nutrition examination survey (NHANES) 1999–2002. J Gen Intern Med. 2007;22(7):1018–23.

    Article  PubMed  Google Scholar 

  30. Baggett TP, Singer DE, Rao SR, O'Connell JJ, Bharel M, Rigotti NA. Food insufficiency and health services utilization in a national sample of homeless adults. J Gen Intern Med. 2011;26(6):627–34.

    Article  PubMed  Google Scholar 

  31. Kushel MB, Gupta R, Gee L, Haas JS. Housing instability and food insecurity as barriers to health care among low-income Americans. J Gen Intern Med. 2006;21(1):71–7.

    Article  PubMed  Google Scholar 

  32. Kalichman SC, Cherry C, Amaral C, et al. Health and treatment implications of food insufficiency among people living with HIV/AIDS, Atlanta, Georgia. J Urban Health. 2010;87(4):631–41.

    Article  PubMed  Google Scholar 

  33. Wang EA, McGinnis KA, Fiellin DA, et al. Food insecurity is associated with poor virologic response among HIV-infected patients receiving antiretroviral medications. J Gen Intern Med. 2011;26(9):1012–8.

    Article  PubMed  Google Scholar 

  34. Weiser SD, Frongillo EA, Ragland K, Hogg RS, Riley ED, Bangsberg DR. Food insecurity is associated with incomplete HIV RNA suppression among homeless and marginally housed HIV-infected individuals in San Francisco. J Gen Intern Med. 2009;24(1):14–20.

    Article  PubMed  Google Scholar 

  35. Weiser SD, Bangsberg DR, Kegeles S, Ragland K, Kushel MB, Frongillo EA. Food insecurity among homeless and marginally housed individuals living with HIV/AIDS in San Francisco. AIDS Behav. 2009;13(5):841–8.

    Article  PubMed  Google Scholar 

  36. Anema A, Weiser SD, Fernandes KA, Brandson EK, Montaner JS, Hogg RS. High prevalence of food insecurity among HIV-infected individuals receiving HAART in a resource-rich setting. AIDS Care. 2010 (In Press).

  37. Vogenthaler NS, Hadley C, Rodriguez AE, Valverde EE, Del Rio C, Metsch LR. Depressive symptoms and food insufficiency among HIV-Infected crack users in Atlanta and Miami. AIDS Behav. Jan 23 2010.

  38. Weiser SD, Tuller DM, Frongillo EA, Senkungu J, Mukiibi N, Bangsberg DR. Food insecurity as a barrier to sustained antiretroviral therapy adherence in Uganda. PLoS One. 2010;5(4):e10340.

    Article  PubMed  Google Scholar 

  39. Weiser SD, Fernandes KA, Brandson EK, et al. The association between food insecurity and mortality among HIV-infected individuals on HAART. J Acquir Immune Defic Syndr. 2009;52(3):342–9.

    Article  PubMed  Google Scholar 

  40. Weiser SD, Tsai AC, Gupta R, et al. Food insecurity is associated with morbidity and patterns of healthcare utilization among HIV-infected individuals in a resource-poor setting. AIDS. 2012;26(1):67–75.

    Article  PubMed  Google Scholar 

  41. McMahon JH, Wanke CA, Elliott JH, Skinner S, Tang AM. Repeated assessments of food security predict CD4 change in the setting of antiretroviral therapy. J Acquir Immune Defic Syndr. 2011;58(1):60–3.

    Article  PubMed  Google Scholar 

  42. Robertson MJ, Clark RA, Charlebois ED, et al. HIV seroprevalence among homeless and marginally housed adults in San Francisco. Am J Public Health. 2004;94(7):1207–17.

    Article  PubMed  Google Scholar 

  43. Zolopa AR, Hahn JA, Gorter R, et al. HIV and tuberculosis infection in San Francisco’s homeless adults. Prevalence and risk factors in a representative sample. JAMA. 1994;272(6):455–61.

    Article  PubMed  CAS  Google Scholar 

  44. Swindale A, Bilinsky P. Development of a universally applicable household food insecurity measurement tool: process, current status, and outstanding issues. J Nutr. 2006;136(5):1449S–52.

    PubMed  CAS  Google Scholar 

  45. Frongillo EA, Nanama S. Development and validation of an experience-based measure of household food insecurity within and across seasons in Northern Burkina Faso. J Nutr. 2006;136(5):1409S–19.

    PubMed  CAS  Google Scholar 

  46. Coates J, Swindale A, Bilinsky P. Household food insecurity access scale (HFIAS) for measurement of food access: indicator guide. Washington, DC: Food and Nutrition Technical Assistance. Academy for Educational Development; 2006.

    Google Scholar 

  47. Gelberg L, Andersen RM, Leake BD. The behavioral model for vulnerable populations: application to medical care use and outcomes for homeless people. Health Serv Res. 2000;34(6):1273–302.

    PubMed  CAS  Google Scholar 

  48. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10.

    Article  PubMed  CAS  Google Scholar 

  49. Weiser SD, Young SL, Cohen CR, et al. Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. Am J Clin Nutr. 2011;94(6):1729S–39.

    Article  PubMed  CAS  Google Scholar 

  50. Anema A, Vogenthaler N, Frongillo EA, Kadiyala S, Weiser SD. Food insecurity and HIV/AIDS: current knowledge, gaps, and research priorities. Curr HIV/AIDS Rep. 2009;6(4):224–31.

    Article  PubMed  Google Scholar 

  51. National Institute on Alcohol Abuse and Alcoholism. The Physician’s Guide to Helping Patients with Alcohol Problems. 1995.

  52. Beck A, Steer R, Garbin M. Psychometric properties of the beck depression inventory: twenty-five years of evaluation. Clin Psychol Rev. 1988;8:77–100.

    Article  Google Scholar 

  53. Riley ED, Bangsberg DR, Perry S, Clark RA, Moss AR, Wu AW. Reliability and validity of the SF-36 in HIV-infected homeless and marginally housed individuals. Qual Life Res. 2003;12(8):1051–8.

    Article  PubMed  CAS  Google Scholar 

  54. Storch EA, Roberti JW, Roth DA. Factor structure, concurrent validity, and internal consistency of the beck depression inventory-second edition in a sample of college students. Depress Anxiety. 2004;19(3):187–9.

    Article  PubMed  Google Scholar 

  55. Weiser SD, Riley ED, Ragland K, Hammer G, Clark R, Bangsberg DR. Brief report: factors associated with depression among homeless and marginally housed HIV-infected men in San Francisco. J Gen Intern Med. 2006;21(1):61–4.

    Article  PubMed  Google Scholar 

  56. Anema A, Weiser SD, Fernandes KA, et al. High prevalence of food insecurity among HIV-infected individuals receiving HAART in a resource-rich setting. AIDS Care. 2011;23(2):221–30.

    Article  PubMed  CAS  Google Scholar 

  57. Riley ED, Moore K, Sorensen JL, Tulsky JP, Bangsberg DR, Neilands TB. Basic subsistence needs and overall health among human immunodeficiency virus-infected homeless and unstably housed women. Am J Epidemiol. 2011;174(5):515–22.

    Article  PubMed  Google Scholar 

  58. Nord M, Coleman-Jensen A, Andrews M, Carlson S. Household food security in the United States, 2009. Washington DC: United States Department of Agriculture (USDA);2010.

  59. Ivers LC, Chang Y, Gregory Jerome J, Freedberg KA. Food assistance is associated with improved body mass index, food security and attendance at clinic in an HIV program in central Haiti: a prospective observational cohort study. AIDS Res Ther. 2010;7:33.

    Article  PubMed  Google Scholar 

  60. Cunningham WE, Andersen RM, Katz MH, et al. The impact of competing subsistence needs and barriers on access to medical care for persons with human immunodeficiency virus receiving care in the United States. Med Care. 1999;37(12):1270–81.

    Article  PubMed  CAS  Google Scholar 

  61. Kim TW, Kertesz SG, Horton NJ, Tibbetts N, Samet JH. Episodic homelessness and health care utilization in a prospective cohort of HIV-infected persons with alcohol problems. BMC Health Serv Res. 2006;6:19.

    Article  PubMed  Google Scholar 

  62. Reid KW, Vittinghoff E, Kushel MB. Association between the level of housing instability, economic standing and health care access: a meta-regression. J Health Care Poor Underserved. 2008;19(4):1212–28.

    Article  PubMed  Google Scholar 

  63. Knowlton AR, Latkin CA, Schroeder JR, Hoover DR, Ensminger M, Celentano DD. Longitudinal predictors of depressive symptoms among low income injection drug users. AIDS Care. 2001;13(5):549–59.

    Article  PubMed  CAS  Google Scholar 

  64. Betz ME, Gebo KA, Barber E, et al. Patterns of diagnoses in hospital admissions in a multistate cohort of HIV-positive adults in 2001. Med Care. Sep 2005;43(9 Suppl):III3–14.

    Google Scholar 

  65. Arno PS, Bonuck KA, Green J, et al. The impact of housing status on health care utilization among persons with HIV disease. J Health Care Poor Underserved. 1996;7(1):36–49.

    Article  PubMed  CAS  Google Scholar 

  66. Gelberg L, Gallagher TC, Andersen RM, Koegel P. Competing priorities as a barrier to medical care among homeless adults in Los Angeles. Am J Public Health. 1997;87(2):217–20.

    Article  PubMed  CAS  Google Scholar 

  67. Katz MH, Cunningham WE, Fleishman JA, et al. Effect of case management on unmet needs and utilization of medical care and medications among HIV-infected persons. Ann Intern Med. 2001;135(8 Pt 1):557–65.

    PubMed  CAS  Google Scholar 

  68. Cunningham CO, Sohler NL, Wong MD, et al. Utilization of health care services in hard-to-reach marginalized HIV-infected individuals. AIDS Patient Care STDS. 2007;21(3):177–86.

    Article  PubMed  Google Scholar 

  69. Aidala A, Cross JE, Stall R, Harre D, Sumartojo E. Housing status and HIV risk behaviors: implications for prevention and policy. AIDS Behav. 2005;9(3):251–65.

    Article  PubMed  Google Scholar 

  70. Leaver CA, Bargh G, Dunn JR, Hwang SW. The effects of housing status on health-related outcomes in people living with HIV: a systematic review of the literature. AIDS Behav. 2007;11(6 Suppl):85–100.

    Article  PubMed  Google Scholar 

  71. Kessell ER, Bhatia R, Bamberger JD, Kushel MB. Public health care utilization in a cohort of homeless adult applicants to a supportive housing program. J Urban Health. 2006;83(5):860–73.

    Article  PubMed  Google Scholar 

  72. Buchanan D, Doblin B, Sai T, Garcia P. The effects of respite care for homeless patients: a cohort study. Am J Public Health. 2006;96(7):1278–81.

    Article  PubMed  Google Scholar 

  73. Kushel MB, Colfax G, Ragland K, Heineman A, Palacio H, Bangsberg DR. Case management is associated with improved antiretroviral adherence and CD4+ cell counts in homeless and marginally housed individuals with HIV infection. Clin Infect Dis. 2006;43(2):234–42.

    Article  PubMed  CAS  Google Scholar 

  74. El-Bastawissi AY, Peters R, Sasseen K, Bell T, Manolopoulos R. Effect of the Washington special supplemental nutrition program for women, infants and children (WIC) on pregnancy outcomes. Matern Child Health J. 2007;11(6):611–21.

    Article  PubMed  Google Scholar 

  75. Pehrsson PR, Moser-Veillon PB, Sims LS, Suitor CW, Russek-Cohen E. Postpartum iron status in nonlactating participants and nonparticipants in the special supplemental nutrition program for women, infants, and children. Am J Clin Nutr. 2001;73(1):86–92.

    PubMed  CAS  Google Scholar 

  76. Kowaleski-Jones L, Duncan GJ. Effects of participation in the WIC program on birthweight: evidence from the national longitudinal survey of youth. Special supplemental nutrition program for women, infants, and children. Am J Public Health. 2002;92(5):799–804.

    Article  PubMed  Google Scholar 

  77. Black MM, Cutts DB, Frank DA, et al. Special supplemental nutrition program for women, infants, and children participation and infants’ growth and health: a multisite surveillance study. Pediatrics. 2004;114(1):169–76.

    Article  PubMed  Google Scholar 

  78. Rose D, Habicht JP, Devaney B. Household participation in the Food Stamp and WIC programs increases the nutrient intakes of preschool children. J Nutr. 1998;128(3):548–55.

    PubMed  CAS  Google Scholar 

  79. Nicholas LH. Can food stamps help to reduce medicare spending on diabetes? Econ Hum Biol. 2011;9(1):1–13.

    Article  PubMed  Google Scholar 

  80. Hamilton WL, Lin BH. Effects of food assistance and nutrition programs on nutrition and health: Volume 3, Literature Review. Food Assistance and Nutrition Research Reports. 2004.

  81. Foster EM, Jiang M, Gibson-Davis CM. The effect of the WIC program on the health of newborns. Health Serv Res. 2010;45(4):1083–104.

    Article  PubMed  Google Scholar 

  82. Leung CW, Willett WC, Ding EL. Low-income supplemental nutrition assistance program participation is related to adiposity and metabolic risk factors. Am J Clin Nutr. 2012;95(1):17–24.

    Article  PubMed  CAS  Google Scholar 

  83. USDA. Trends in Supplemental Nutrition Assistance Program participation rates: Fiscal Years 2002–2009 2011; http://www.fns.usda.gov/ora/menu/Published/snap/SNAPPartNational.htm. Accessed 9 June, 2012.

  84. Coleman-Jensen A, Nord M, Andrews M, Carlson S. Household food security in the United States, 2010. Washington DC: United States Department of Agriculture (USDA);2011.

  85. Fremstad S. A Modern Framework for Measuring Poverty and Basic Economic Security. Washington, DC: Center for Economic and Policy Research;2010.

  86. Heflin CM, Mueser P. Assessing the Impact of a Modernized ApplicationProcess on Florida’s Food Stamp Caseload. Lexington: University of Kentucky Center for PovertyResearch;2010.

  87. Cantrell RA, Sinkala M, Megazinni K, et al. A pilot study of food supplementation to improve adherence to antiretroviral therapy among food-insecure adults in Lusaka, Zambia. J Acquir Immune Defic Syndr. 2008;49(2):190–5.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This publication was made possible by grant no. UL1 RR024131 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR or the NIH. Information on NCRR is available at http:///www.ncrr.nih.gov.

Contributors

We thank the collaborating researchers including Kathleen McCartney, Richard Clark, Greg Barnell, John Day, Nelia Dela Cruz, Minoo Gorji, Scot Hammond, Jackie Haslam, Zizi Hawthorne, Jay Jankowski, Rhonda Johnson, Mac McMaster, Sandra Monk, Rebecca Packard, Joyce Powell, Kathleen Ragland, Mathew Reynolds, Paul Rueckhaus, Jacqueline So, John Weeks and Kelly Winslow.

Funders

NIMH 54907, 79713-01; CHRP ID08-SF-054; UCSF Academic Senate; Hurlbut-Johnson funds from AIDS Research Institute award, UCSF, no. 557858-8-148. The authors acknowledge the following additional sources of salary support: the Burke Family Foundation and the Hellman Family Foundation (to Dr. Weiser), and K24 MH-87227 (to Dr. Bangsberg).

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sheri D. Weiser MD, MPH.

Additional information

Please address all requests for reprints to the corresponding author.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Weiser, S.D., Hatcher, A., Frongillo, E.A. et al. Food Insecurity Is Associated with Greater Acute Care Utilization among HIV-Infected Homeless and Marginally Housed Individuals in San Francisco. J GEN INTERN MED 28, 91–98 (2013). https://doi.org/10.1007/s11606-012-2176-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-012-2176-4

Key words

Navigation