This study focused on determining the proportion, factors affecting of food insecurity among PLWHA taking antiretroviral therapy. Majority 201 (63.0%) of the study participants were food insecure which is higher than the reports form study done in British Columbia, Canada  where 48% of PLWHA were food insecure while it is lower than the one reported from Dire Dawa (Ethiopia) , 72.4% of the households were food insecure. This might be due to the variation in the socio economic status of the two study areas and the measurement taken in the food security status at household level in case of Dire Dawa while the current study assessed the individual food insecurity experiences of PLWHA.
The proxy indicators of food security status used in this study to support the ten items for assessment of food security also showed that significant number of PLWHA on ART 59.6% and 55.8% had low mean meal frequency and dietary diversity score, respectively. Similar findings were documented in Côte d’Ivoire and Uganda [22, 23].
Educational status was one of the predictors of food insecurity with PLWHA’s whose educational status is lesser than elementary level being more likely to be food insecure than those who educated higher than elementary level. This finding is consistent with the findings of other reports [21, 24, 25]. Educated PLWHA will have an opportunity to involve in better income generation activity than less educated and may fulfill their dietary needs. Average family monthly income was one also of the predictors of food insecurity status with PLWHA in households earning average family monthly income less than 100 USD per month being more likely to be food insecure compared to those earning more. Another study also reported that PLWHAs earning less than 10, 000 Canadian dollars per year were 4 times more likely to be food insecure . Findings of the longitudinal study done in Jimma zone to assess adolescent’s food security also showed family socioeconomic status has significance association with food insecurity . People living in food constrained households share similar shocks which might be rather worse for PLWHAs owing to the discrimination that becomes fueled due to the shortages of food or others resources to purchase food. This has significant programmatic implication in that addressing the poverty and food insecurity issues among PLWHA is a critical element in achieving a better treatment and clinical outcome to ART. PLWHAs might even face economic problems due to cut down of their earnings due to frequent sickness days that they have passed. Additionally, unemployment promotes poverty, which contributes to food insecurity [25, 27, 28]. In the same manner, the mood changes produced by the lack of a steady job can impact compliance with treatment and medical appointments related to the person’s HIV condition . The lessons learned from the early phase of the HIV Equity Initiative (HEI) was that the context of poverty factors such as lack of access to transport, food insecurity, and user fees for medical care, posed more significant barriers to adhering to long-term therapy than a patient’s individual behavior  and the most likely cause of non adherence to antiretroviral (ARV) drug therapy .
The other pertinent finding is the low food diversity and meal frequency which are directly related with food insecurity. Our study showed that those PLWHA who had lower than the mean diversity score were 2.18 times more likely to be food insecure which is consistent with the finding reported in another study . The majority of the study households reported to have consumed fewer than six food groups, which was mainly cereals. This is evidence in a study conducted in Uganda which showed a significant increase in the number of food groups consumed with increased food security score .
The findings of this study should be interpreted with some limitations. Because it was conducted at a single site, the findings may not be generalizable to dissimilar clinical settings and a result of cross-sectional study design nature, the temporal sequence of events cannot be determined. Recall bias and social desirability bias are also potential limitations that may have been encountered in this study.