Co-occurring psychosocial problems predict HIV status and increased health care costs and utilization among sexual minority men

Abstract

Sexual orientation related health disparities are well documented. Sexual minority men appear to be at risk for mental health problems due to the stress they experience in establishing and maintaining a minority sexual identity. These mental health issues may combine synergistically and lead to higher medical costs to society. We examine whether sexual minority specific syndemic indicators were associated with higher health care costs, health care utilization, or the risk of being HIV-infected. Health care consumers at a community health center (N = 1211) completed a brief screening questionnaire collected over 12 months. Self-reported data were linked with participants’ clinical billing records. Adjusted logistic regression models identified that four syndemic indicators (suicidality, substance use, childhood sexual abuse, and intimate partner violence) were each significantly related to each other. Multiple syndemics significantly predicted higher medical care utilization and cost, and were associated with 2.5 times the risk of being HIV-infected (OR 2.49, 95% CI 1.45–4.25). Syndemic indicators did not significantly predict the number of mental health visits or costs per patient. These results confirm and extend earlier findings by relating syndemics to health services use and costs for sexual minority men.

Effects of syndemic psychiatric diagnoses on health indicators in men who have sex with men.

“…Our results have several clinical implications that extend to population-level health management. First, consistent with other syndemic assessments, individuals with more problems, in this case psychiatric diagnoses, have a higher likelihood of engaging in high-risk sex and utilizing costly emergency health care (O’Cleirigh et al, 2018). These results indicate that clinicians should be aware of the higher need for intervention among patients grappling with comorbid diagnoses, including encouraging engagement in preventative and early stage health care.…”

Examining a Syndemics Network Among Young Latino Men Who Have Sex with Men

“…Syndemics are comprised of multiple, co-occurring psychosocial (e.g., depression, substance use, intimate partner violence) and structural (e.g., unstable housing, poverty, prison history) conditions that theoretically interact synergistically, forming a syndemic that creates worse health outcomes than would the presence of multiple conditions that are not synergistic [1]. Psychosocial syndemic indicators have been shown to be additively associated with negative health behaviors in men who have sex with men (MSM) [2][3][4][5][6][7][8]. Cross-sectional studies among MSM with varying demographics and age groups, and in various countries, have generally demonstrated a positive association between increasing numbers of psychosocial syndemic indicators and increased risk behaviors for HIVand other sexually transmitted infections (STI) [2][3][4][5][6][7], and for having an HIV-positive serostatus [4][5][6][7][8].…”

“…Psychosocial syndemic indicators have been shown to be additively associated with negative health behaviors in men who have sex with men (MSM) [2][3][4][5][6][7][8]. Cross-sectional studies among MSM with varying demographics and age groups, and in various countries, have generally demonstrated a positive association between increasing numbers of psychosocial syndemic indicators and increased risk behaviors for HIVand other sexually transmitted infections (STI) [2][3][4][5][6][7], and for having an HIV-positive serostatus [4][5][6][7][8]. For example, increasing numbers of psychosocial syndemic indicators are positively related to increased risk for engaging in condomless anal sex [2][3][4][5][6][7] and having multiple sexual partners [3,5].…”

“…For example, increasing numbers of psychosocial syndemic indicators are positively related to increased risk for engaging in condomless anal sex [2][3][4][5][6][7] and having multiple sexual partners [3,5]. Cross-sectional studies have also found that increasing numbers of psychosocial syndemic indicators are associated with having an HIV-positive serostatus [4][5][6][7][8].…”

“…Synergistic effects have been posited in syndemic theory as intertwined and mutually enhancing effects arising from social and health problems [1], as further described below. However, in practice, syndemic effects have been tested with a variety of approaches-most often a linear, additive approach [2][3][4][5][6][7][8]. A linear, additive approach is useful to enhance understanding of the relationship between syndemic indicators and HIV risk in clinical practice, such that clinicians are able to tailor their approach for their individual client within the context of increasing HIV risk with increasing numbers of syndemic indicators.…”