Food insecurity as a social determinant of sexual health and substance use independent of poverty status among men who have sex with men in the United States

Purpose: To characterize the prevalence of food insecurity among men who have sex with men (MSM) and assess its associations with sexual health measures and substance use, as compared to poverty status.Methods: In 2017, 10,049 US MSM were recruited online and completed the American Men's Internet Sur-vey. The survey assessed food insecurity, annual household income and past-year behaviors: condomless anal intercourse, exchange sex, any illicit substance use other than marijuana, use of methamphetamine, alkyl nitrites or gamma-hydroxybutyrate (GHB), HIV testing, and sexually transmitted infection testing and diagnosis. We tested associations between behavioral outcomes and food insecurity or poverty, con-trolling for demographic characteristics.Results: The prevalence of food insecurity among AMIS participants was 15.8%. Food insecurity nonre-sponse was 2.5% while income nonresponse was 19.0%. Food insecurity was significantly and positively associated with all behavioral outcomes, while poverty was significantly and positively associated only with exchange sex, any illicit substance use, methamphetamine, and GHB use. In models that included both food insecurity and poverty as exposures, food insecurity remained independently positively asso-ciated with all behavioral outcomes and the associations for poverty level were null for all outcomes except methamphetamine and GHB use. Conclusions: Assessing food insecurity in sexual health and substance use survey research may provide a more robust indicator of economic deprivation and provide insight for HIV and STI prevention interven-tions.Published by Elsevier Inc.