Characterising a syndemic among black women at risk for HIV: the role of sociostructural inequity and adverse childhood experiences

Abstract

Objectives Black women disproportionately experience STIs (including HIV/AIDS), gender-based violence, substance misuse and mental health conditions. Addressing a gap in syndemic research, we characterised comorbidity overlap within the context of sociostructural inequities and adverse childhood experiences (ACEs) among black women in Baltimore, Maryland.Methods Between 2015 and 2018, black women (n=305) were recruited from STI clinics in Baltimore, Maryland. Among those with complete survey data (n=230), we conducted a latent class analysis to differentiate women based on their profile of the following syndemic comorbidities: STIs, adult sexual victimisation, substance misuse and mental health disorders. We then examined the association between ACEs and syndemic latent class membership.Results Thirty-three percent of women experienced three to nine ACEs before age 18 years, and 44% reported four to six comorbidities. The two-class latent class solution demonstrated the best fit model, and women were categorised in either class 1 (past-year STI; 59%) or class 2 (syndemic comorbidities; 41%). Women in class 2 were more likely to report unstable housing (10% vs 3%) and identify as bisexual/gay (22% vs 10%) than women in class 1. ACEs were significantly associated with an increased likelihood of class 2 membership.Conclusions This study reinforces the importance of screening for ACEs and offering trauma-informed, integrated care for black women with syndemic comorbidities. It also highlights the critical nature of tailoring interventions to improve sociostructural equity, preventing and reducing syndemic development.

Perspectives on HIV pre-exposure prophylaxis (PrEP) implementation in Mississippi among Black women and clinical staff: Recommendations for clinical trauma-informed programs

“…In 2018, Black women account for 58 % of infections among U.S. women ( Centers for Disease Control and Prevention, 2017a ); and account for 67 % of all new HIV infections in the U.S. South, a region with the highest HIV incidence in the country ( Centers for Disease Control and Prevention, 2017b ). Black women at-risk for HIV endure several forms of violence such as sexual coercion ( Gutzmer et al, 2016 ), childhood violence ( Tsuyuki et al, 2022 ), and IPV ( Stockman et al, 2013 ). IPV can increase Black women’s HIV acquisition risk through forced sex, compromised condom negotiation, stress dysregulation, and increased engagement in risky sex ( Stockman et al, 2013 , Dunkle and Decker, 2013 , Overstreet et al, 2015 ).…”