Date of Completion


Embargo Period



HIV, Food insecurity, Medication Adherence, Multilevel Modeling

Major Advisor

Seth C. Kalichman, PhD

Associate Advisor

Blair T. Johnson, PhD

Associate Advisor

Tania B. Huedo-Medina, PhD

Field of Study



Doctor of Philosophy

Open Access

Open Access


Limited access to resources based on social position can significantly impact health behaviors. Previous research on food insecurity and HIV has focused on establishing the relationship between food insecurity and antiretroviral (ARV) medication non-adherence in a variety of social contexts (i.e. resource poor and resource rich environments). However, one main caveat of these studies is the level of analysis. Previous studies have used cross-sectional and longitudinal studies that concentrate on the individual level of analysis. However, these study designs do not allow for a true test of whether ARV medication non-adherence occurs on days with limited access to food.

The current study utilized a prospective, observational design to test the daily relationship between food insecurity and medication non-adherence. Fifty-nine adults living with HIV were enrolled. They were followed for 45 days and completed daily assessments of food insecurity and alcohol use via two way text message surveys. Participants also used Wisepill devices to assess daily medication adherence. Results showed that severe food insecurity (i.e. hunger) significantly predicted missed doses of medication on a daily level. This relationship was moderated by alcohol use but not geospatial factors. Additionally, psychosocial factors did not mediate this relationship. There are several potential explanations for this daily relationship including competing resource demands and food requirements of prescriptions. Future research should tease apart these potential explanations in order to better understand the daily relationship between food insecurity and medication non-adherence and the ways that we can intervene.