Urban garden project seeks to reduce food insecurity and improve outcomes for people with HIV

A University of Massachusetts Amherst public health scientist has received a five-year, $3.4 million grant from the National Institute of Mental Health to lead an urban gardening and peer nutritional counseling program aimed at improving the health of HIV-positive people with food insecurity in the Dominican Republic.

The project involving an international team of researchers and community partners is believed to the first full-scale trial to integrate nutritional counseling with food-generating activities among people with HIV who have food insecurity, says principal investigator Kathryn Derose, professor of community health education. The research also supportsnational and international goals of achieving viral suppression and reducing the disease and economic burden of HIV.

A little over a decade ago in Latin America and the Caribbean, as highly effective antiretroviral therapy (ART) was made widely available for people with HIV, Derose discovered an unexpected barrier to effective treatment.

“We kept hearing from people we interviewed that food insecurity – not having food to take the medication with – was either causing people to not take it or to take it irregularly,” says Derose, acting director of the Center for Community Health Equity Research. “This was interesting because everybody was all worried about the cost of this treatment, and the problem was people not having food. And those early lines of therapy particularly required that they be taken with food because the medication was very toxic to the system.”

The new randomized, controlled trial, called ProMeSA – which means promise and is an acronym for Project to Improve Food Security – was preceded by several pilot projects in Latin America and the Caribbean, including a ProMeSA pilot in the Dominican Republic that showed positive results. Among participants in the pilot, the intervention decreased food insecurity, reduced detectable viral loads and missed clinic appointments, and increased ART adherence.

HIV ranks as one of the top five causes of death in the Dominican Republic, and the team’s previous work found that nearly 70% of people with HIV have moderate or severe food insecurity. “In Latin America, the people living with food insecurity tend to span the nutritional spectrum, from underweight to overweight and obesity,” Derose says, explaining the need for not just nonperishable food that can be more easily delivered, but for fresh fruits and vegetables. “We started thinking about it and proposed urban gardens as the food access component, paired with the peer nutritional counseling, which would me more appropriate across the spectrum of nutritional status and more sustainable in the long term.”

The project continues an international partnership among researchers from UMass Amherst; the University of California, San Francisco, where the study’s other principal investigator, Kartika Palar, is based; the RAND Corporation, where Derose was working when she began this research; and the Universidad Autonóma de Santo Domingo, as well as the Dominican Ministries of Agriculture and Public Health, the Dominican National HIV/AIDS Council and the United Nations World Food Program. 

The team will implement the program in seven provinces that have the highest HIV prevalence in the country. They will measure the effects on HIV clinical outcomes and food security, as well as other important outcomes such as internalized and experienced stigma, at six months, 12 months and 18 months.

 “Social relations are intentionally strengthened in the intervention,” Derose says. “The garden training is done in groups, and there are cooking workshop that integrate nutritional knowledge, education and the gardens. And the peer nutritional counseling is also a social intervention and incorporates the peer leader’s experience growing a garden and eating healthy on a low income. These components are all meant to reinforce each other and interrupt the ways that food insecurity leads to poor HIV outcomes, and we will be able to look at this in fine detail in this larger study.”

The findings ultimately may have a broader application to help people with food insecurity who have other medical conditions, such as diabetes, an area that Palar has examined. “We will have the numbers to inform not only this intervention going forward but potentially other interventions that are trying to address food insecurity among people with chronic disease,” Palar says.