Psychosocial Health Problems Increase Risk for HIV Among Urban Young Men Who Have Sex With Men: preliminary Evidence of a Syndemic in Need of Attention

Institute for Juvenile Research at the University of Illinois at Chicago, Department of Psychiatry, and Children's Memorial Hospital, IL 60608, USA.
Annals of Behavioral Medicine (Impact Factor: 4.2). 09/2007; 34(1):37-45. DOI: 10.1080/08836610701495268
Source: PubMed

ABSTRACT Young men who have sex with men (YMSM) experience disparities in HIV rates and potentially in mental health, substance abuse, and exposure to violence.
We assessed the extent to which these psychosocial health problems had an additive effect on increasing HIV risk among YMSM.
An urban sample of 310 ethnically diverse YMSM reported on psychosocial health problems, sexual risk behaviors, and HIV status. A count of psychosocial health problems was calculated to test the additive relationship to HIV risk.
The prevalence of psychosocial health problems varied from 23% for regular binge drinking to 34% for experiencing partner violence. Rates of sexual risk behaviors were high and 14% of YMSM reported receiving a HIV+ test result. Psychosocial health problems cooccurred, as evidenced by significant bivariate odds ratios (ORs) between 12 of the 15 associations tested. Number of psychosocial health problems significantly increased the odds of having multiple anal sex partners (OR=1.24), unprotected anal sex (OR=1.42), and an HIV-positive status (OR 1.42), after controlling for demographic factors.
These data suggest the existence of cooccurring epidemics, or "syndemic," of health problems among YMSM. Disparities exist not only in the prevalence of HIV among YMSM but also in research to combat the epidemic within this vulnerable population. Future research is needed to identify risk and resiliency factors across the range of health disparities and develop interventions that address this syndemic.

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    • "They found that the presence of the co-occurring epidemics increased the likelihood that MSM had engaged in unprotected sex and increased their likelihood of being HIV-positive. A number of authors, particularly during the past few years, have written about syndemics and Syndemics Theory as they apply to sexual risk taking and the HIV epidemic (Gielen et al., 2007; Mustanski , Garofalo, Herrick, & Donenberg, 2007; Romero-Daza, Weeks, & Singer, 2003; Senn, Carey, & Vanable, 2010; Singer et al., 2006), including specific mention of the applicability of the concept and theory to men who have sex with men (Klein, 2011b; Mustanski et al., 2007). "
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    ABSTRACT: PURPOSE: This study examines the prevalence of depression in a sample of MSM who are at high risk for HIV. It examines the relationship between depressive symptomatology and involvement in HIV risk behaviors, and the factors associated with greater depressive symptomatology. METHODS: The data come from a national random sample of 332 MSM who used any of 16 websites to identify men with whom they could engage in unprotected sex. Data were collected via telephone interviews. RESULTS: Depression was more prevalent in this population (26.7%) than among men in the general population. Depression was not related directly to any of the HIV risk behaviors examined, but it was related to men’s attitudes toward condom use, which was the strongest predictor of their involvement in risky behaviors. Five factors were identified as being associated with greater depression: lower educational attainment, greater discrimination based on sexual orientation, greater eroticizing of ejaculatory fluids, experiencing more substance abuse problems, and greater childhood maltreatment. CONCLUSIONS: Depression is a consequential problem in this population. Although depression does not appear to be related directly to HIV risk practices in this population, its influence cannot be discounted because of its effects on other key predictors of risk involvement.
    Journal of Gay & Lesbian Mental Health 04/2014; 18:164-189. DOI:10.1080/19359705.2013.834858
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    • "This manuscript presents findings from one of the first research studies to test a theory of syndemics in aging HIV-positive gay, bisexual, and other MSM. Although previous studies have highlighted the strong relations between psychosocial burdens and sexual risk-taking in age-diverse samples of MSM (Egan et al. 2011; Moeller et al. 2011; Stall et al. 2003), much of the focus of this research has been on the applicability of syndemics theory to understanding sexual risk-taking in adolescent, emerging, and young adult gay, bisexual, and other MSM (Halkitis et al. 2013; Mustanski et al. 2007; Solomon et al. 2011; Storhlom et al. 2011). Like these previous investigations, we demonstrate a high level of association between psychosocial burdens and UAI, with the men who possessed higher overall burden scores also indicating a higher likelihood of engaging in UAI. "
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    ABSTRACT: The theory of syndemics has been widely applied in HIV-prevention studies of gay, bisexual, and other MSM (men who have sex with men) over the last decade. Our investigation is the first to consider the applicability of the theory in a sample of aging (ages 50 and over) HIV-positive MSM, which is a growing population in the United States. A sample of 199 men were actively recruited and assessed in terms of mental health and drug-use burden, as well as sexual risk behaviors. Bivariate and multivariable analyses indicate a high level of association between psychosocial burdens (i.e., drug use and mental health) and same-sex unprotected sexual behaviors, providing initial support for the applicability of the theory of syndemics to this population. Further support can be seen in participants’ narratives. Findings suggest the mutually reinforcing nature of drug use, psychiatric disorders, and unprotected sexual behavior in older, HIV-positive, gay, bisexual, and other MSM, highlighting the need for holistic strategies to prevention and care among this population of older and sexually active individuals. In short, the generation of gay men who came of age in the late 1970s and 1980s, “the AIDS Generation,” are continuing to mature such that further efforts must be enacted to meet the multidimensional nature of these men's physical, mental, and sexual health needs.
    11/2012; 36(2). DOI:10.1111/napa.12009
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    • "This type of methodology may shed light on the inconsistency in research findings by mapping the venues in which partners were met onto individual sexual encounters. For example, in his daily diary study, Mustanski (2007b) used a combined retrospective and prospective approach to investigate meeting partners online and sexual risk in MSM. Results indicated that the association between these two variables was opposite when comparing retrospective versus prospective accounts. "
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    ABSTRACT: Epidemiological studies have found that young men who have sex with men (YMSM) represent the majority of young people infected with HIV annually in the United States. Further, they are one of the few risk groups to show an increase in the rate of infections in recent years. In addition to these disparities in prevalence and infection rates, there is an inequity in prevention and intervention research on this population. The purpose of this article is to review the existing YMSM literature on HIV epidemiology, correlates of risk, and intervention research. The article concludes that promising future directions for basic research include a focus on multiple clustering health issues, processes that promote resiliency, the role of family influences, and the development of parsimonious models of risk. In terms of intervention research, the article suggests that promising future directions include Internet-based intervention delivery, integration of biomedical and behavioral approaches, and interventions that go beyond the individual level to address partnership, structural, community, and network factors.
    The Journal of Sex Research 03/2011; 48(2-3):218-53. DOI:10.1080/00224499.2011.558645 · 2.53 Impact Factor
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