Between March and August 2010, we approached a total of 113 recently-released individuals in Connecticut, Texas, and California for participation in the study. We enrolled 110 individuals in the study, amounting to a participation rate of 97%. Forty-six percent of participants were female, 37% were living on the streets or homeless, and 30% had minor children living in the home (). The median time since release for this sample was 124 days (IQR 74–237 days). A majority of participants (91%, N = 100) reported any food insecurity (9.1% marginal food security, 72.7% low food security, and 9.1% very low food security). Rates of food insecurity did not vary by the time post release. The Cronbach's alpha of the FSM items in this sample was 0.9. Among the 41 participants who reported not having eaten for an entire day, 39% reported receiving SNAP food benefits, where the median monthly benefit was $200 and lasted 18 days out of the month.
Participants Recently Released from Prison, N = 110
We found no association between the various categories of food insecurity and HIV risk behaviors in the entire sample (see ). We did find associations between not having eaten for an entire day and HIV risk behaviors. Participants who went without food for an entire day were more likely to use alcohol (78% vs. 36%, p = 0.002), heroin (30% vs. 6%, p = 0.02), and cocaine (57% vs. 20%, p = 0.004) prior to sex and to exchange sex for money (26% vs. 8%, p = 0.04) compared to those who had at least one meal each day. They were more likely to use opioids prior to sex (30% vs. 10%, p = 0.06), though this association was only marginally significant. We did not find associations between not eating for an entire day and other HIV risk behaviors, such as condom use or sharing or exchanging needles or drug paraphernalia. Finally, formerly incarcerated individuals who did not eat for an entire day were more likely to live in a state with a SNAP food benefit ban compared to a state without a SNAP food benefit ban (78% vs. 42%, p < 0.001).
Association Between Not Eating for an Entire Day, HIV Risk Behaviors, and Presence of SNAP Food Benefit Ban, N = 110
Multivariate adjustment for age, sex, race/ethnicity altered the association between not eating for an entire day and some, but not all, HIV risk behaviors (). After adjustment, participants who had not eaten for an entire day had twenty times greater odds of using alcohol (AOR 20.7, 95% CI [3.7, 114.7]) and six times greater odds of using cocaine (AOR 6.1, 95% CI [1.6, 23.3]) prior to intercourse compared to those who had eaten at least one meal each day. Sex work and using heroin prior to intercourse were no longer significantly associated with not having eaten in an entire day in multivariate models. Controlling for the presence of a state SNAP food benefit ban reduced the odds of alcohol and cocaine use before sex, suggesting that the ban may impact the association between not eating for an entire day and certain HIV risk behaviors.
Association Between Not Having Eaten for an Entire Day and HIV Risk Behaviors, N = 110