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Open Paper

Behavioral Medicine, Chronic Illness, and Integrated Primary Care

Chronic Illness, HIV, Chronic Pain, and Fear of Disease Progression: Intervention Development and Testing

1 - (OP6) Not Having Enough Food? That Makes My Heart Very Painful: Qualitative Exploration of the Role of Food Insecurity on Medication Adherence and Mental Health Among People with HIV in South Africa

Thursday, June 25, 2026
11:35 AM - 11:52 AM PDT
Location: Yerba Buena Salon 11, B3 Level
Keywords: HIV / AIDS, Adherence, Transdiagnostic
Recommended Readings: Singer, M., Bulled, N., Ostrach, B., & Mendenhall, E. (2017). Syndemics and the biosocial conception of health. The lancet, 389(10072), 941-950.,   ,   ,   ,  


Background: Globally, food insecurity is a prevalent problem among people with HIV (PWH), leading to worse physical, mental, and social well-being. Our prior research among PWH in Khayelitsha, South Africa found a prevalence of at least mild food insecurity of 81%. In the present study, we explored the interrelationships of food insecurity with HIV medication adherence, depression, and PTSD among PWH using a syndemic framework.

Method: Eligible individuals were PWH in Khayelitsha who reported non-adherence to antiretroviral therapy (ART) in the past 30 days, at least mild food insecurity in the past 30 days, and screened positive for either depression or post-traumatic stress. We explored experiences relating to food insecurity, adherence, depression, and PTSD using in-depth, semi-structured qualitative interviews. Interviews were conducted in isiXhosa and translated and transcribed for analyses. Using a rapid framework analysis, transcripts were coded by 9 team members and a random 33% of transcripts were double-coded. Subsequently, qualitative data were summarized, and themes extracted.

Results: Participants (N=30) were 39.7 years old on average (SD=8.1), mostly women (n=20, 66%), and most met diagnostic criteria for depression (n=20, 66%) or PTSD (n=18, 60%), and experienced severe food insecurity (not having any food to eat in a day; n=28, 93%). Qualitative analyses identified food insecurity as one of the main barriers interfering with ART adherence via schedule disruptions and side effects (e.g., increased appetite, dizziness, fatigue) or anticipated side effects due to the absence of food. Food insecurity directly contributed to experiences of generalized distress, low mood, irritability, anhedonia, and suicidal ideation via the direct effects of food insecurity on mood as well as impairments in social functioning and themes of personal failure, hopelessness, and helplessness, leading to stigma when experiencing food insecurity. We also identified behavioral inhibition, avoidance, and shame as major experiences contributing to depressed mood and PTSD.

Discussion: Food insecurity was identified by participants as an overwhelming stressor. Food insecurity has direct negative effects on mental health via direct impairments in mood as well as shame, interfering with role functioning and social support. Findings highlight the integral role of addressing food insecurity across both medication adherence and mental health programs and provide evidence for the syndemic nature of food insecurity with mental and physical functioning. Food insecurity is a salient problem with downstream effects on mental health and medication adherence, creating daily urgency and distress that interfere with one’s ability to engage in problem-solving or social support.

Learning Objectives:

  • Better understand the complex interrelationships between depression, trauma, and food insecurity through a syndemic framework lens, and understand intervention development priorities.