The Syndemic Effects of Intimate Partner Violence, HIV/AIDS, and Substance Abuse on Depression among Low-Income Urban Women

Illangasekare, Samantha; Burke, Jessica G.; Chander, Geetanjali; Gielen, Andrea Carlson

doi:10.1007/s11524-013-9797-8

Cited by 94 publications

(61 citation statements)

References 64 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…21 The association of sexual risk with substance use, including heavy alcohol use is well documented. 6,27 This study confirms the association of this individual level factor in this at-risk sample of women in three urban areas. Recent research among urban women has documented the syndemic nature of substance use, partner violence, depression and HIV risk, 27 with qualitative research describing how various syndemic factors may act as catalysts for each other.…”

Section: Discussionsupporting

confidence: 82%

“…6,27 This study confirms the association of this individual level factor in this at-risk sample of women in three urban areas. Recent research among urban women has documented the syndemic nature of substance use, partner violence, depression and HIV risk, 27 with qualitative research describing how various syndemic factors may act as catalysts for each other. 28 Interrupting the proximal and interactive effects of these syndemic experiences on each other and sexual risk behavior outcomes is crucial.…”

Section: Discussionsupporting

confidence: 82%

“…Recent incarceration was experienced by one in six women, as observed in other samples of urban women. 16,27 Many of these structural factors are correlated with each other. Further, these structural barriers were associated with substance use and incarceration, illustrating the overlapping nature of challenges facing the women.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

HIV Sexual Risk and Syndemics among Women in Three Urban Areas in the United States: Analysis from HVTN 906

et al. 2015

View full text Add to dashboard Cite

on behalf of the HVTN 906 study team ABSTRACT Limited data are available on the longitudinal occurrence of syndemic factors among women at risk for HIV infection in the USA and how these factors relate to sexual risk over time. HVTN 906 was a longitudinal study enrolling 799 HIV-uninfected women in three cities. Assessments were done at baseline, 6, 12, and 18 months to assess syndemic factors (low education, low income, unemployment, lack of health insurance, housing instability, substance use, heavy alcohol use, partner violence, incarceration) and sexual risk outcomes. For each sexual risk outcome, a GEE model was fit with syndemic factors or syndemic score (defined as sum of binary syndemics, ranging from 0 to 9), visit, study site, age and race/ethnicity as predictors to examine the multivariable association between syndemic factors and outcomes over time. Odds of unprotected sex while drunk or high were significantly higher when women reported lack of health insurance, substance and heavy alcohol use and partner violence. Housing instability, substance and heavy alcohol use, partner violence and recent incarceration were associated with higher odds of having multiple sexual partners. Odds of sex exchange were significantly higher in the presence of unemployment, housing instability, low education, lack of health insurance, substance and heavy alcohol use, partner violence and incarceration. Housing instability, substance and heavy alcohol use, and partner violence were significantly associated with higher odds of unprotected anal sex. Odds of having a recent STI were significantly higher when women reported housing instability and partner violence. There were significantly higher odds of the reporting of any risk outcomes during follow-up with higher syndemic score. This study highlights a group of women experiencing multiple poor social and health outcomes who need to be the focus of comprehensive interventions.

show abstract

Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 82%

See 1 more Smart Citation

HIV Sexual Risk and Syndemics among Women in Three Urban Areas in the United States: Analysis from HVTN 906

et al. 2015

View full text Add to dashboard Cite

show abstract

“…4,5 These factors may negatively affect health outcomes in myriad ways, including decreased engagement in HIV care, 6 and reduced adherence to medications. 7,8 An estimated 8% of HIV-positive people in the US abuse alcohol, 9,10 while onethird of HIV patients receiving care report active drug use. 10 Both alcohol and drug abuse are associated with poor ART adherence and viral suppression failure.…”

Section: Introductionmentioning

confidence: 99%

“…A syndemic approach to health disparities directs us to consider the excess burden of ''entwined and mutually enhancing health problems,'' 21 fueled by social and economic inequities. 22 Though the SAVA-related psychosocial problems have been widely studied among HIV-positive women in the US, 23 and some research has looked at SAVA effects on mental health, 7 few studies directly test syndemic models among this population, and none to our knowledge, have tested additive SAVA syndemic effects on viral load suppression among HIVpositive women in the US.…”

Section: Introductionmentioning

confidence: 99%

Substance Abuse, Violence, and HIV/AIDS (SAVA) Syndemic Effects on Viral Suppression Among HIV Positive Women of Color

Sullivan

Messer

Quinlivan

2015

AIDS Patient Care and STDs

142

View full text Add to dashboard Cite

The combined epidemics of substance abuse, violence, and HIV/AIDS, known as the SAVA syndemic, contribute to the disproportionate burden of disease among people of color in the US. To examine the association between HIV viral load suppression and SAVA syndemic variables, we used baseline data from 563 HIV + women of color treated at nine HIV medical and ancillary care sites participating in HRSA's Special Project of National Significance Women of Color (WOC) Initiative. Just under half the women (n = 260) were virally suppressed. Five psychosocial factors contributing to the SAVA syndemic were examined in this study: substance abuse, binge drinking, intimate partner violence, poor mental health, and sexual risk taking. Associations among the psychosocial factors were assessed and clustering confirmed. A SAVA score was created by summing the dichotomous (present/absent) psychosocial measures. Using generalized estimating equation (GEE) models to account for site-level clustering and individual-covariates, a higher SAVA score (0 to 5) was associated with reduced viral suppression; OR (adjusted) = 0.81, 95% CI: 0.66, 0.99. The syndemic approach represents a viable framework for understanding viral suppression among HIV positive WOC, and suggests the need for comprehensive interventions that address the social/environmental contexts of patients' lives.

show abstract

A longitudinal study of associations between HIV‐related stigma, recent violence and depression among women living with HIV in a Canadian cohort study

et al. 2019

View full text Add to dashboard Cite

Introduction Women living with HIV (WLHIV) experience stigma and elevated exposure to violence in comparison with HIV‐negative women. We examined the mediating role of experiencing recent violence in the relationship between stigma and depression among WLHIV in Canada. Methods We conducted a cohort study with WLHIV in three Canadian provinces. Recent violence was assessed through self‐reported experiences of control, physical, sexual or verbal abuse in the past three months. At Time 1 (2013‐2015) three forms of stigma were assessed (HIV‐related, racial, gender) and at Time 2 (2015‐2017) only HIV‐related stigma was assessed. We conducted structural equation modelling (SEM) using the maximum likelihood estimation method with Time 1 data to identify direct and indirect effects of gender discrimination, racial discrimination and HIV‐related stigma on depression via recent violence. We then conducted mixed effects regression and SEM using Time 1 and Time 2 data to examine associations between HIV‐related stigma, recent violence and depression. Results At Time 1 (n = 1296), the direct path from HIV‐related stigma (direct effect: β = 0.200, p < 0.001; indirect effect: β = 0.014, p < 0.05) to depression was significant; recent violence accounted for 6.5% of the total effect. Gender discrimination had a significant direct and indirect effect on depression (direct effect: β = 0.167, p < 0.001; indirect effect: β = 0.050, p < 0.001); recent violence explained 23.15% of the total effect. Including Time 1 and Time 2 data (n = 1161), mixed‐effects regression results indicate a positive relationship over time between HIV‐related stigma and depression (Acoef: 0.04, 95% CI: 0.03, 0.06, p < 0.001), and recent violence and depression (Acoef: 1.95, 95% CI: 0.29, 4.42, p < 0.05), controlling for socio‐demographics. There was a significant interaction between HIV‐related stigma and recent violence with depression (Acoef: 0.04, 95% CI: 0.01, 0.07, p < 0.05). SEM analyses reveal that HIV‐related stigma had a significant direct and indirect effect on depression over time (direct effect: β = 0.178, p < 0.001; indirect effect: β = 0.040, p < 0.001); recent violence experiences accounted for 51% of the total effect. Conclusions Our findings suggest that HIV‐related stigma is associated with increased experiences of recent violence, and both stigma and violence are associated with increased depression among WLHIV in Canada. There is an urgent need for trauma‐informed stigma interventions to address stigma, discrimination and violence.

show abstract

The Syndemic Effects of Intimate Partner Violence, HIV/AIDS, and Substance Abuse on Depression among Low-Income Urban Women

Cited by 94 publications

References 64 publications

HIV Sexual Risk and Syndemics among Women in Three Urban Areas in the United States: Analysis from HVTN 906

HIV Sexual Risk and Syndemics among Women in Three Urban Areas in the United States: Analysis from HVTN 906

Substance Abuse, Violence, and HIV/AIDS (SAVA) Syndemic Effects on Viral Suppression Among HIV Positive Women of Color

A longitudinal study of associations between HIV‐related stigma, recent violence and depression among women living with HIV in a Canadian cohort study

Contact Info

Product

Resources

About