A Social Ecological Model of Syndemic Risk affecting Women with and At‐Risk for HIV in Impoverished Urban Communities

Abstract

Syndemic risk is an ecological construct, defined by co-occurring interdependent socio-environmental, interpersonal and intrapersonal determinants. We posited syndemic risk to be a function of violence, substance use, perceived financial hardship, emotional distress and self-worth among women with and at-risk for HIV in an impoverished urban community. In order to better understand these interrelationships, we developed and validated a system dynamics (SD) model based upon peer-reviewed literature; secondary data analyses of a cohort dataset including women living with and at-risk of HIV in Bronx, NY (N = 620); and input from a Bronx-based community advisory board. Simulated model output revealed divergent levels and patterns of syndemic risk over time across different sample profiles. Outputs generated new insights about how to effectively explore multicomponent multi-level programs in order to strategically develop more effective services for this population. Specifically, the model indicated that effective multi-level interventions might bolster women's resilience by increasing self-worth, which may result in decreased perceived financial hardship and risk of violence. Overall, our stakeholder-informed model depicts how self-worth may be a major driver of vulnerability and a meaningful addition to syndemic theory affecting this population.

The Potential of Pre-Exposure Prophylaxis for Women in Violent Relationships

“…12 In addition, the psychological sequelae of partner violence (e.g., depression, suicidal ideation) as well as substance abuse, which is associated with IPV victimization, have been shown to increase sexual risk taking and thus contribute to HIV infection. 15,16 Women's risks are compounded by the fact that perpetrators of IPV are themselves at higher risk of HIV infection, being more likely than nonperpetrators to engage in HIV risk behaviors, such as partner concurrency and transactional sex, [17][18][19] and to be diagnosed with a STI/HIV. 18,20 Violent partners are also more likely to refuse condom use.…”

Prevalence, type, and correlates of trauma exposure among adolescent men and women in Soweto, South Africa: implications for HIV prevention

“…Little attention, however, has focused on gendered impacts and the presence of syndemic risks which can have a multiplicative effect on HIV risk [20], including multiple types of PTEs (e.g. physical, sexual, and emotional) [21].…”

Profiles of Resilience and Psychosocial Outcomes among Young Black Gay and Bisexual Men

“…These problems constitute a syndemic that exacerbates poor health among YBGBM (Mustanski, Garofalo, Herrick & Donenberg, 2007;Penniman Dyer et al, 2012;Wilson et al, 2014) and other vulnerable populations (Batchelder, Gonzalez, Palma, Schoenbaum & Lounsbury, 2015;Halkitis et al, 2012;Mimiaga et al, 2015;Nehl, Klein, Sterk & Elifson, 2015;Stall, Friedman & Catania, 2007). Through both structural and interpersonal mechanisms, minority stress shapes outcomes among YBGBM by exposing them to race-and sexual orientation-based stigma and lower levels of personal and social resources that can be used to combat stress (Hatzenbuehler, 2010;Meyer, 2010).…”