Measurement Model Exploring a Syndemic in Emerging Adult Gay and Bisexual Men

Abstract

The current study was designed to develop a better understanding of the nature of the relationships between mental health burden, drug use, and unprotected sexual behavior within a sample of emerging adult gay and bisexual men, ages 18–19 (N = 598) and to test a theory of syndemics using structural equation modeling. Participants were actively recruited from community-based settings and the Internet for participation in a seven-wave cohort study. Data for participant characteristics and mental health were collected via computer-assisted survey, while drug use and unprotected sex behaviors for the month prior to assessment were collected via a calendar-based technique. Using the baseline data, we developed and tested structural equation models for mental health burden, drug use, and unprotected sex and also tested a second-order model for a single syndemic. First-order measurement models for each of the three epidemics were successfully identified using observed data. Tests of a second-order model seeking to explain the three epidemics as a single syndemic fit poorly. However, a second-order construct comprised of mental health burden and drug use fit the data well and was highly associated with the first-order construct of unprotected sex. The findings advance a theory of syndemics and suggest that in order to be maximally effective both HIV prevention and HIV care must be delivered holistically such that sexual risk behaviors are addressed in relation to, and in sync with, the drug use and mental health of the individual.

Early Life Psychosocial Stressors and Housing Instability among Young Sexual Minority Men: the P18 Cohort Study

“…31 In this study, we propose that understanding how mental, physical, and social health, which may include housing instability, relate to one another is critical to developing holistic services and programs to help combat negative health effects experienced by sexual minority men. 19 More importantly, this theory provides a lens through which to examine the psychosocial drivers that predispose sexual minority individuals to higher rates of HIV, 32 substance use, 33 violence, 34 and housing instability, among other interconnected health challenges, with the potential to develop holistic, all-encompassing interventions.…”

“…Study details were previously described in detail and are briefly summarized here. 18,19 Participants were recruited through a combination of community outreach methods including flyers and Internet advertisements as well as venue-based (e.g., community centers, college campuses, bars/clubs, etc.) methods between June 2009 and May 2011.…”

Using Syndemic Theory to Understand Vulnerability to HIV Infection among Black and Latino Men in New York City

“…Subsequent work by Stall and colleagues identified other psychosocial risks contributing to syndemic conditions, including sexual compulsiveness, stress, and discrimination. 23,24 Perry Halkitis and his colleagues 25 also have employed syndemic theory to understand vulnerability to poor health outcomes among young MSM. Data were collected from 598 young (between the ages of 18 and 19 years) MSM living in NYC, the majority of whom (53 %) were Hispanic or Black.…”

A review of the syndemic components of male same-sex intimate partner violence

“…However, discrimination and social stigma continue to exist for gay men, especially those who are young and/or from racial/ethnic minority populations. [9,10] This stigma, along with bullying of non-gender conforming adolescents and negative media messaging results in high rates of mental health problems among gay men. [11] Over the past twenty years, researchers have identified varying rates of MSSIPV, including psychological abuse rates between 33% to 73.2%, [12] sexual violence rates in current relationships from 9.8% to 28.1%, [13] and physical abuse rates from 11.8% to 45.1%.…”

“…[23] Through structural equation modeling, mental health issues and substance abuse comes before high-risk sexual behaviors in regard to activity; whereas prior research that used regression and correlPublished by Sciedu Press ative models subsume simultaneity with which these correlates match. [9,55] …”