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

Northwestern University, Evanston, Illinois, United States
Annals of Behavioral Medicine (Impact Factor: 4.2). 09/2007; 34(1):37-45. DOI: 10.1080/08836610701495268
Source: PubMed


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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    • "The differences between the terms comorbid and syndemic, as Mustanski et al. stress [23], is not simply semantic. Research guided by a comorbidity model tends to focus on the disease boundaries, overlaps, and prioritization, while syndemic research directs attention to “communities experiencing co-occurring epidemics that additively increase negative health consequences [23]”. The adverse synergistic interaction of diseases in syndemics, in other words, multiplies the burden of disease in a population, and, under given conditions, can escalate contagion, disease progression, disability, and mortality. "
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    • "Researchers in Western societies have found that men who have sex with men (MSM) and gay and bisexual men tend to experience more psychosocial problems such as depression, suicide, and intimate partner violence than their heterosexual counterparts (Herrick et al., 2011; Mustanski et al., 2007; Operario and Nemoto, 2010; Safren et al., 2010; Senn et al., 2010; Walkup et al., 2008). MSM also exhibit higher rates of cigarette smoking, alcohol abuse and drug use, and infection rates of HIV and other STIs (Colfax et al., 2004; Klein, 2011; Marshal et al., 2008; Rhodes et al., 1999; Van Tieu and Koblin, 2009; Walkup et al., 2008). "
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