Food insecurity among people who inject drugs in Athens, Greece: a study in the context of ARISTOTLE Programme.

OBJECTIVE To measure prevalence of food insecurity and explore related characteristics and behaviors among people who inject drugs (PWID). DESIGN Cross-sectional analysis of a community-based program for HIV infection among PWID (ARISTOTLE programme). Food insecurity was measured by the Household Food Insecurity Access Scale (HFIAS). Computer-assisted interviews and blood samples were also collected. SETTING A fixed location in Athens Metropolitan Area, Greece, during 2012-2013. PARTICIPANTS In total, 2,834 unique participants with history of injecting drug use in the past 12 months were recruited over four Respondent-Driven Sampling rounds (approximately 1,400/ round). RESULTS More than 50% of PWID were severely or moderately food insecure across all rounds. PWID were more likely to be severely food insecure if they were older than 40 years [adjusted Odds Ratio (aOR):1.71, 95% Confidence Interval (95% CI):1.33-2.19], were women (aOR:1.49, 95% CI:1.17-1.89), from Middle East countries (aOR vs. from Greece: 1.80, 95%CI: 1.04, 3.11), had a lower educational level (primary or secondary school vs higher education; aOR:1.54, 95% CI:1.29-1.84), had no current health insurance (aOR:1.45, 95% CI:1.21-1.73), were homeless (aOR:17.1, 95% CI:12.3-23.8) or were living with another drug user (aOR:1.55, 95% CI:1.26-1.91) as compared to those living alone or with family/friends. HIV-infected PWID were more likely to be severely food insecure compared to uninfected (59.0% vs. 51.0% respectively, p=0.002); however, this difference was attributed to the confounding effect of homelessness. CONCLUSIONS Moderate/severe food insecurity was a significant problem, reaching >50% in this sample of PWID and closely related to socio-demographic characteristics and especially homelessness.