Women in Botswana and Swaziland who do not have enough food to eat are more likely to engage as sex workers putting them at risk of HIV infection.
These are the findings of a major study of over 2000 people by Dr Sheri Weiser (University of California San Francisco, USA) and her colleagues in the United States, Botswana, and Swaziland, reported in the international open access journal PLoS Medicine.
In many parts of sub-Saharan Africa, women have little control over food supplies but are expected to feed their children and other members of the household (such as elders). The researchers conducted their study to see whether women who lack food sell sex, become sexually involved with men of a different generation, or engage in other risky behaviors.
The researchers therefore studied the link between food insufficiency (not having enough food to eat over the previous 12 months), sex exchange (exchanging sex for money, food, or other resources over the previous 12 months), intergenerational sex, inconsistent condom use, and other measures of risky sex.
Nearly one in three women reported food insufficiency. After allowing for variables such as education and income, women in both countries who reported food insufficiency were nearly twice as likely to have used condoms inconsistently with a non-regular partner or to have sold sex as women who had had sufficient food. They were also more likely to have had intergenerational sexual relationships and to report a lack of control in sexual relationships.
These findings strongly suggest that protecting and promoting access to food may decrease vulnerability of women in sub-Saharan Africa to HIV infection.
In a related Perspective article, Professor Nigel Rollins (University of KwaZulu-Natal, Durban, South Africa), who was not involved in the study, says that 'the message of the study is clear: in the absence of adequate food for oneself or one's family, individuals will forfeit long-term personal safety to survive today.'
Professor Rollins says that these findings provide 'an additional rationale, even obligation, to consider hunger alleviation as a central component of HIV prevention programmes.'