Longitudinal Effects of Syndemics on HIV-Positive Sexual Minority Men’s Sexual Health Behaviors

Abstract

Objective-This study examined the longitudinal effects of co-occurring psychosocial concerns, or syndemics, on HIV-positive sexual minority men's likelihood of engaging in serodiscordant condomless anal sex (CAS), a health behavior with implications for personal and public health.Methods-Participants included 390 HIV-positive sexual minority men from two prior secondary prevention trials. Over the course of the one-year data collection period (up to 5 observations per participant), participants completed self-report measures of CAS, as well as six syndemic factors: post-traumatic stress disorder, childhood sexual abuse, depression, anxiety, alcohol abuse, and poly sub stance/stimulant use. We employed multilevel modeling to examine the longitudinal additive effect of syndemics on serodiscordant CAS (binary) over the one-year period.Results-The number of syndemic conditions was a significant predictor of CAS, with each additional syndemic associated with 1.41 greater odds of CAS (p = 0.0004; 95% CI [1.16, 1.70]). Both the between-(p = 0.0121, 95% CI [1.07, 1.69]) and within-person (p = 0.01, 95% CI [1.11, 2.10]) effects of syndemics were significant predictors, showing that an increase in the number of syndemic conditions across person and time both increased odds of CAS.Conclusions-Interventions addressing HIV-positive sexual minority men's sexual health behaviors should address the potential impact of co-occurring psychosocial concerns that affect Correspondence concerning this article should be addressed to Audrey Harkness, Clinical Research Building (C-204),

Estimating HIV transmissions in a large U.S. clinic‐based sample: effects of time and syndemic conditions

“…Prior studies of syndemic conditions among PLWH showed additive associations with increased odds of ART non-adherence [36][37][38][39][40]43], virological non-suppression [38,40,43] and condomless sex with serodiscordant partners while virally unsuppressed [42,43]. However, these studies have generally treated the outcomes of interest as dichotomous outcomes: ART adherent versus non-adherent [36,39,40,43]; virally suppressed versus unsuppressed [40,43]; and the presence or absence of condomless sex while virally unsuppressed [42,43]. Our study builds upon these past findings by quantifying estimated HIV transmissions longitudinally associated with co-occurring syndemic conditions among a diversity of risk groups of PLWH in care.…”

“…Our study adds to growing literature on syndemic conditions and transmission risk behaviour among PLWH. Prior studies of syndemic conditions among PLWH showed additive associations with increased odds of ART non-adherence [36][37][38][39][40]43], virological non-suppression [38,40,43] and condomless sex with serodiscordant partners while virally unsuppressed [42,43]. However, these studies have generally treated the outcomes of interest as dichotomous outcomes: ART adherent versus non-adherent [36,39,40,43]; virally suppressed versus unsuppressed [40,43]; and the presence or absence of condomless sex while virally unsuppressed [42,43].…”

“…More recent syndemic research has focused on co-occurring syndemic conditions among PLWH as predictors of HIV transmission risk (e.g. ART nonadherence, uncontrolled viral load or biobehavioural transmission risk behaviour) [35][36][37][38][39][40][41][42][43]. Other studies have linked psychosocial variables (notably, depression) and substance use (notably, stimulants), though not their additive effects, to elevated viral load and worse HIV clinical outcomes [9,[44][45][46][47][48][49][50][51][52].…”

Structural Life Instability and Factors Related to Latino Sexual Minority Men’s Intention to Engage with Biomedical HIV-Prevention Services

“…Although rates of HIV-testing are higher amongst Latina/o/x individuals and LSMM compared to their White heterosexual counterparts [ 11 ], people identifying as Latina/o/x are still at higher risk of late HIV diagnoses [ 12 ] and being undiagnosed [ 13 ] compared to other racial/ethnic groups. Compounding cultural factors and structural barriers such as lack of health insurance, immigration concerns, and financial hardship may also influence low PrEP uptake and suboptimal HIV-testing frequency amongst people who identify as Latino [ 14 , 15 ]. Therefore, addressing these psychosocial and structural barriers that affect HIV-testing and PrEP engagement among LSMM is a necessary step in working towards the Ending the HIV Epidemic goals and improving HIV-related care for a population facing disparities [ 16 ].…”

Psychosocial Problems and Condomless Anal Sex among Transgender Women in Two Cities of China: Study Based on the Syndemic Framework

“…Data from a systematic review showed that the median lifetime prevalence of physical intimate partner violence (IPV) was 37.5%, the lifetime sexual IPV was 25.0% among transgender individuals, and they were 1.7 times more likely to experience any IPV compared to cisgender individuals [ 22 ]. According to previous studies, psychosocial problems are linked to the sexual risk behaviors of TGW, such as CAS, thus increasing the risk of HIV acquisition [ 23 , 24 , 25 , 26 , 27 ]. In Lima, Peru, a survey of 328 TGW found an association between physical IPV and condomless receptive anal sex (CRAS) [ 28 ].…”