Co-occurring epidemics, syndemics, and population health

Tsai, Alexander C.; Mendenhall, Emily; Trostle, James; Kawachi, Ichiro

doi:10.1016/s0140-6736(17)30403-8

Cited by 213 publications

(190 citation statements)

References 49 publications

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“…Concomitant with the rapid expansion in the magnitude of the opioid overdose crisis is an expansion in its scope, with increasingly syndemic [6] involvement of cocaine and psychostimulants [7][8][9][10]. There are multiple, interrelated, and deeply rooted social and economic determinants of the US opioid overdose crisis, none of which are likely to provide a sufficient explanation for the crisis when considered in isolation [11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Stigma as a fundamental hindrance to the United States opioid overdose crisis response

et al. 2019

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• The current United States opioid overdose crisis is a complex, multifaceted, public health emergency that urgently requires the implementation of evidence-based primary, secondary, and tertiary preventive interventions. We develop a typology of the stigma related to opioid use, showing how multiple dimensions of stigma continue to fundamentally hinder the response to the crisis. • Public stigma is driven by stereotypes about people with opioid use disorders, such as their perceived dangerousness or perceived moral failings, which translate into negative attitudes toward people with opioid use disorders. • Enacted stigma describes the behavioral manifestations of public stigma, including discrimination and social distancing. Public and enacted stigma, in turn, lead to delivery of suboptimal care and undermine access to treatment and harm reduction services. • Public stigma and enacted stigma can become structural stigma when they become encoded in cultural norms, laws, and institutional policies. Collectively, these forms of stigma run at cross purposes to-and reduce public support for-public health-oriented policies to address the opioid overdose crisis.

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Section: Introductionmentioning

confidence: 99%

Stigma as a fundamental hindrance to the United States opioid overdose crisis response

et al. 2019

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“…On the other hand, situations such as loneliness or lack of supportive social networks were associated with lower self-care. In this regard, it is essential to consider a syndemic approach that allows explaining behaviors from different levels, as well as the social determinants of health 27 . From this perspective, the importance of having the social support of family and friends has been shown, since the absence of social capital is a factor that promotes risky sexual practices and, thus, the vulnerability to contracting HIV and other STIs 28 .…”

Section: Discussionmentioning

confidence: 99%

Trabajadores sexuales masculinos: entre el sexo seguro y el riesgo. Etnografía en una sauna gay de Barcelona, España

Jacques-Aviñó

Andrés

Roldán

et al. 2019

Ciênc. saúde coletiva

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Resumen Esta etnografía se realizó en Barcelona, ciudad que ofrece diferentes recursos de ocio homosexual, como las saunas gay. El objetivo fue analizar desde los estudios sobre género y masculinidades, cómo se articula la sexualidad, la percepción sobre la infección por VIH y otras infecciones de transmisión sexual (ITS), y las medidas preventivas en trabajadores sexuales masculinos (TSM) usuarios de saunas gay. Se realizaron 10 entrevistas en profundidad y observación entre 2012 y 2016. Las prácticas de sexo seguro son más frecuentes con clientes, mientras que las de riesgo se realizan más con parejas no comerciales. La orientación sexual juega un rol relevante, los homosexuales asumen más prácticas de riesgo en el trabajo sexual que los heterosexuales. Consumo de drogas o la escasez de redes de apoyo se relacionaron con mayor vulnerabilidad social y conductas de riesgo. Contraer el VIH aún genera miedo, mientras que tener otras ITS se percibe como parte de la vida sexual de un hombre. El TSM afianza una masculinidad con múltiples parejas sexuales, breadwinner y por otra parte, cuestiona un modelo heteronormativo. Las intervenciones para la prevención del VIH e ITS en este colectivo, deberían considerar los determinantes sociales como las precarias alternativas laborales y el ofrecer mayor soporte social.

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“…Quantitative studies are crucial for unravelling how epidemics and large-scale social forces interact at both the population and individual levels to worsen the burden of disease. Analysts have recently argued for developing new quantitative multilevel models that can account for both how individual-level risk factors interact to affect disease outcomes and how large-scale social forces condition the distribution of individual-level risk factors or expedite their interaction and translation into disease states (Tsai et al, 2017). Yet qualitative social science studies have an equally central role to play in the efforts to understand and respond to syndemics, because they are uniquely suited to exploring how those who are affected by the syndemics experience and make sense of syndemic-forming health and social conditions.…”

Section: Discussionmentioning

confidence: 99%

Experiencing Syndemic: Disentangling the Biosocial Complexity of Tuberculosis Through Qualitative Research

et al. 2018

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Tuberculosis (TB) remains a major global public health problem that has become a crisis fuelled by HIV and the increasing occurrence of antimicrobial resistance. What has been termed the biosocial nature of TB challenges effective control of the disease. Yet, biosocial interactions involved in the persistence of TB in diverse settings are difficult to systematically account for. The recently developed framework of syndemics provides a way to capture how complex health problems result from the interactions between diseases such as HIV and TB, and harmful social conditions such as unemployment, malnutrition and substance abuse. This article advances the syndemics scholarship by examining health conditions that cluster together with TB in the Russian Federation, by eliciting a set of social processes that precipitate this clustering and exacerbate health outcomes, and by analysing interactions between these health conditions and social processes. To provide an account of this complexity, the article takes a qualitative approach and draws on the perspectives and experiences of people with TB. The results demonstrate emergence of a syndemic of stress, substance abuse, TB and HIV that is sustained by poverty, occupational insecurity, marginalization and isolation. Frictions between the narrow focus of the health care system on TB and the wider syndemic processes in which the lives of many persons with TB are embedded, contribute to poorer health outcomes and increase the risks of developing drug resistance. Finally, the article argues that the large-scale and impersonal forces become embodied as individual pathology through the crucial interface of the ways in which persons experience and make sense of these forces and pathologies. Qualitative research is needed for the adequate analysis of this biosocial complexity in order to provide a solid basis for responses to TB-centred syndemics in various settings.

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Co-occurring epidemics, syndemics, and population health

Cited by 213 publications

References 49 publications

Stigma as a fundamental hindrance to the United States opioid overdose crisis response

Stigma as a fundamental hindrance to the United States opioid overdose crisis response

Trabajadores sexuales masculinos: entre el sexo seguro y el riesgo. Etnografía en una sauna gay de Barcelona, España

Experiencing Syndemic: Disentangling the Biosocial Complexity of Tuberculosis Through Qualitative Research

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