Human Immunodeficiency Virus (HIV) infection has been shown to lead to food insecurity and severe malnutrition, as it hits the productive age groups the most, thereby causing a fall in the family income, and reduced food availability for the entire household. [1]. This malnutrition in early childhood affects the cognitive, psychosocial and physical development, and also affects academic performance of the child [2]. A cross-sectional study was conducted in the Anti-retroviral Treatment (ART) Center of a government tertiary-care hospital in Chennai between August and December 2012, to evaluate the status of food security among households with HIV-infected children, and to correlate it with the nutritional status and growth of the child. Households were eligible to participate if they had at least one child aged between 1 year to 15 years infected with HIV, living with them for longer than 6 months and getting treatment at the study center. To assess food insecurity, we used the 9-item Household Food Insecurity Access Scale (HFAIS) questionnaire adapted from the Food and Nutrition Technical Assistance project for use in low resource settings [3]. The questionnaire was administered to the primary caregivers - parent (mother or father) or a guardian (grandmother or grandfather) by face-to-face interviews by staff who were familiar with the caregiver. Nutritional indices, height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ) z-scores were calculated using WHO reference medians [4]. For this study, Wasting was defined as WHZ of <-2 standard deviation (SD), Stunting was defined as HAZ of <-2SD, and Underweight defined as WAZ of <-2 SD below normal. Institutional Ethics Committee approval and signed informed written consent from participants were obtained.

We interviewed caregivers from 150 households during the study period. Three parents dropped out as they did not feel comfortable with the questions, leaving a final sample of 147 households with 147 children. Mean (SD) age and weight of the children was 7.8 (3.6) years and 19.5 (8) kgs, respectively. 66% of the children had mothers who were infected with HIV. Of the 147 households studied, food insecurity with hunger was present in 46.3% (95%CI 38.4-54.3), food insecurity without hunger in 10.9% (95%CI.6.8-16.95) and food security in 41.5% (95%CI 33.8 - 49.56) (Web Table I). Prevalence of some degree of food insecurity without consideration of hunger status was present in more than half of the households surveyed (58.5%, 95%CI.50.4 to 66.1). 41% (58/142) of children were stunted; 50% (72/145) underweight and 15% (17/113) wasted. Stunting (31% vs 69%); underweight (28% vs 72%) and wasting (23.5% vs 76.5%) were more common among children in >5 year than those below 5 year.

Our study reveals that 58.5% of households with HIV-infected children are food insecure, which is similar to the prevalence of food insecurity in general population in India [5,6]. Data from the NFHS-3 has shown the National average of underweight and stunting to vary between 40% to 50% and 48% to 60%, respectively for under-five children [10]. We found a higher proportion of above-five year old children underweight (72%) and stunted (69%), similar to other studies [7,8]. However, household food insecurity was not significantly associated with underweight and stunting, which was unexpected, given the evidence that a household’s access to food is one of the key determinants of a child’s nutritional status. However, in countries with high stunting rates, under-five underweight rates may not be a good indicator of food insecurity [9].

This study highlights the fact that over half of the children living with HIV also suffer from household food insecurity, which could affect their growth and development leading to stunting and wasting. Interventions like targeted food assistance to such families, in addition to ART, is the need of the hour.

Contributors: ES, ASV: Study conduct; RS: Data cleaning and Data analysis; Joel: Manuscript writing; PP: Study protocol development, conduct and Manuscript preparation.

Funding: None; Competing Interest: None stated.

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