Food Insecurity Among Sexual and Gender Diverse Persons in Brazil: Impact of COVID-19 Pandemic and Associations with Antiretroviral Nonadherence Among People Living with HIV

Food insecurity has re-emerged as a critical issue in Brazil, significantly worsened by the COVID-19 pandemic. We recruited Brazilian sexual and gender diverse (SGD) persons aged 18 + years on apps and social media across three periods: early (2020), late (2021), and post-COVID-19 (2024) pandemic. We explored two outcomes: food insecurity (all participants) and antiretroviral (ART) nonadherence (only persons living with HIV). Food insecurity was assessed using the 8-item version of the Brazilian Household Food Insecurity Measurement Scale. ART nonadherence was defined as reporting < 100% medication adherence in the past 30 days. Logistic regression models assessed factors associated with each outcome. In total, 22,327 participants were included (74.6% HIV-negative; 17.9% living with HIV, 7.5% HIV-unknown), mean age 37 years, 96.3% cisgender men. Compared to the early pandemic period, lower odds of experiencing food insecurity were observed for late (adjusted odds ratio [aOR]:0.65, 95% confidence interval [CI]:0.59-0.71) and post-pandemic (aOR:0.66, 95%CI:0.60-0.73) periods. Participants who reported to be living with HIV had higher odds of experiencing food insecurity (aOR:1.21, 95%CI:1.11-1.31). Food insecurity increased the odds of ART nonadherence (aOR:2.36, 95%CI:1.57-3.63). Compared to early pandemic period, late (aOR:2.69, 95%CI:1.81-4.09) and post (aOR:3.61. 95%CI:2.49-5.39) pandemic periods were associated with higher odds of ART nonadherence. Our study shows food insecurity as a critical barrier to optimal ART adherence among Brazilian SGD living with HIV. Although the experience of food insecurity decreased in the two most recent periods, its enduring association with HIV infection and ART adherence underscores the urgent necessity for comprehensive and integrated public policies.