Income limits for SNAP eligibility are inversely associated with new HIV diagnoses

April 04, 2021

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HIV diagnoses have a statistically significant association with state income limits for eligibility for the Supplemental Nutrition Assistance Program, researchers reported in the Open Forum Infectious Diseases.

“After years of falling HIV cases in the US, the number of new infections has risen to around 39,000 a year since 2013.” Aaron Richterman, MD, MPH, Healio said, an infectious disease fellow at the University of Pennsylvania Hospital.

The state income limits for SNAP eligibility were inversely linked to the number of new HIV diagnoses between 2010 and 2014.
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Given this lack of progress, the U.S. government announced a federal plan in 2019 to bring that number down to fewer than 3,000 new infections per year by 2030, Richterman said.

At the same time, the U.S. Department of Agriculture, under the Trump administration, proposed several rule changes to the Supplemental Nutrition Assistance Program (SNAP), the primary federal food safety net program that has been shown to reduce the resulting food insecurity and poverty for millions of people who have access to SNAP lose, ”he said.

Richterman stated that one of these changes would include the removal of a policy known as broad categorical eligibility, allowing states to raise the income limit for SNAP eligibility and raise or remove the wealth limit for eligibility.

“Because of the established and close relationship between food insecurity and HIV outcomes, we hypothesized that restricting access to SNAP would potentially undermine efforts to end the HIV epidemic in the US. So we did a study over a 5-period period (2010-2014) to test how changes in income or wealth limits over time in states are related to new HIV infections, ”he said.

According to the study, there were 204,034 new HIV diagnoses in the US between 2010 and 2014, with an annual incidence rate of 16.8 diagnoses per 100,000 people in 2010, which fell each year to a low of 14.9 in 2013 before it Increased to 15.1 in 2014.

The study showed that HIV diagnoses within states had a statistically significant association with state income limits for SNAP eligibility (incidence rate rate) [IRR] = 0.94 per increase in the income limit by 35% of federal poverty; 95% CI, 0.91-0.98), but no association with government wealth limits (increased wealth limit vs. no change, IRR = 1.02, 95% CI, 0.94-1.10; removed wealth limit vs. none Change, IRR = 1.04, 95% CI, 0.99-1.10).

Richterman said that, based on 2018 numbers and everyone else alike, if all states had raised the SNAP income line from the current 200% of the federal poverty line, it would be linked to 1,732 fewer HIV cases. If all states had lowered the SNAP income line from the current 130% of the federal poverty line, this would result in 2,755 more HIV cases.

“This is an example of how our social safety net is an essential tool in the fight against the HIV epidemic and should be used in efforts to end the HIV epidemic in the United States. Expanding access to SNAP could be a way to reduce new HIV infections, ”Richterman said. “People with an unsafe diet take antiretroviral therapy less often, are examined regularly for clinical treatment and are suppressed virologically. They are also more likely to use high-risk coping strategies like swapping sex for food. Because of this, HIV transmission becomes more likely. “

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