Disclosures: The authors report no relevant financial disclosures.
April 04, 2021
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Income limits for SNAP eligibility inversely associated with new HIV diagnoses

Disclosures: The authors report no relevant financial disclosures.
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HIV diagnoses have a statistically significant association with state income limits for Supplemental Nutrition Assistance Program eligibility, researchers reported in Open Forum Infectious Diseases.

“After years of falling HIV cases in the United States, the number of new infections has plateaued at around 39,000 per year since 2013,” Aaron Richterman, MD, MPH, an infectious diseases fellow at the Hospital of the University of Pennsylvania, told Healio.

HIV under a microscope
State income limits for SNAP eligibility were inversely associated with the number of new HIV diagnoses between 2010 and 2014.
Source: Adobe Stock

Amid this lack of progress, the U.S. government announced in 2019 a federal plan to reduce this number to less than 3,000 new infections per year by 2030, Richterman noted.

“However, 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 proven to reduce food insecurity and poverty that would result in millions of people losing access to SNAP,” he said.

Richterman explained that one of these changes would involve getting rid of a policy called broad-based categorical eligibility, which allows states to increase the income limit for SNAP eligibility and to increase or eliminate the asset limit for eligibility.

“Because of the proven and close relationship that has been shown to exist between food insecurity and HIV outcomes, we hypothesized that reducing access to SNAP would possibly undermine efforts to end the HIV epidemic in the U.S., so we designed a study of a 5-year period (2010-2014) to test how changes in the income or asset limits over time in states were related to new HIV infections,” he said.

According to the study, there were 204,034 new HIV diagnoses in the U.S. between 2010 and 2014, with an annual incidence rate of 16.8 diagnoses per 100,000 persons in 2010, decreasing each year to a low of 14.9 in 2013 before increasing to 15.1 in 2014.

The study demonstrated that HIV diagnoses within states had a statistically significant association with state income limits for SNAP eligibility (incidence rate ratio [IRR] = 0.94 per increase in the income limit by 35% of federal poverty level; 95% CI, 0.91-0.98), but no association with state asset limits (increased asset limit vs. no change, IRR = 1.02, 95% CI, 0.94-1.10; eliminated asset limit vs. no change, IRR = 1.04, 95% CI, 0.99-1.10).

Richterman said that, based on 2018 numbers and all else being equal, if all states had increased the SNAP income limit from where they currently are to 200% of the federal poverty level, it would be associated with 1,732 fewer HIV cases. If all states had decreased the SNAP income limit to 130% of the federal poverty level from where they currently are, it would be associated with 2,755 more HIV cases.

“This is one example of how our social safety net is an important tool for controlling the HIV epidemic and should be leveraged in efforts to end the HIV epidemic in the U.S. While broad-based categorical eligibility is not currently under threat under the Biden administration, expansion of access to SNAP may be one way to help reduce new HIV infections,” Richterman said. “People who are food insecure are less likely to take antiretroviral therapy, follow up regularly for clinical care, and be virologically suppressed. They are also more likely to use high-risk coping strategies like exchanging sex for food. Because of this, HIV transmission becomes more likely.”