A Syndemic Model of Exchange Sex Among HIV-Positive Men Who Have Sex With Men

Walters, Suzan M.; Braksmajer, Amy; Coston, Bethany M.; Yoon, Irene S.; Grov, Christian; Downing, Martin J.; Teran, Richard; Hirshfield, Sabina

doi:10.1007/s10508-020-01628-8

Cited by 32 publications

(28 citation statements)

References 101 publications

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“…Recruitment of participants and data collection was carried out at an established SSP in NYC, which offered a comprehensive array of services. NYC has many accessible harm reduction facilities, unlike most cities in the USA [35,36]. Therefore, our findings may not be generalizable to other PWID populations and treatment environments, particularly those outside of NYC and other areas that are not well-resourced.…”

Section: Limitationsmentioning

confidence: 80%

“They look at us like junkies”: influences of drug use stigma on the healthcare engagement of people who inject drugs in New York City

et al. 2020

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Background: People who inject drugs (PWID) are a medically and socially vulnerable population with a high incidence of overdose, mental illness, and infections like HIV and hepatitis C. Existing literature describes social and economic correlations to increased health risk, including stigma. Injection drug use stigma has been identified as a major contributor to healthcare disparities for PWID. However, data on this topic, particularly in terms of the interface between enacted, anticipated, and internalized stigma, is still limited. To fill this gap, we examined perspectives from PWID whose stigmatizing experiences impacted their views of the healthcare system and syringe service programs (SSPs) and influenced their decisions regarding future medical care. Methods: Semi-structured interviews conducted with 32 self-identified PWID in New York City. Interviews were audio recorded and transcribed. Interview transcripts were coded using a grounded theory approach by three trained coders and key themes were identified as they emerged. Results: A total of 25 participants (78.1%) reported at least one instance of stigma related to healthcare system engagement. Twenty-three participants (71.9%) reported some form of enacted stigma with healthcare, 19 participants (59.4%) described anticipated stigma with healthcare, and 20 participants (62.5%) reported positive experiences at SSPs. Participants attributed healthcare stigma to their drug injection use status and overwhelmingly felt distrustful of, and frustrated with, medical providers and other healthcare staff at hospitals and local clinics. PWID did not report internalized stigma, in part due to the availability of non-stigmatizing medical care at SSPs. Conclusions: Stigmatizing experiences of PWID in formal healthcare settings contributed to negative attitudes toward seeking healthcare in the future. Many participants describe SSPs as accessible sites to receive high-quality medical care, which may curb the manifestation of internalized stigma derived from negative experiences in the broader healthcare system. Our findings align with those reported in the literature and reveal the potentially important role of SSPs. With the goal of limiting stigmatizing interactions and their consequences on PWID health, we recommend that future research include explorations of mechanisms by which PWID make decisions in stigmatizing healthcare settings, as well as improving medical care availability at SSPs.

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Section: Limitationsmentioning

confidence: 80%

“They look at us like junkies”: influences of drug use stigma on the healthcare engagement of people who inject drugs in New York City

et al. 2020

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“…The syndemics framework clarifies how multiple factors are also associated with increased risk of COVID-19. Street-based sex workers often operate at the margins of society and experience multiple, syndemic conditions including homelessness, hunger, poverty, substance use, and mental health issues (Bauermeister et al, 2017 ; Biello et al, 2014 ; Parsons et al, 2018 ; Walters et al, 2020a ). Paradoxically, despite challenges experienced by this group, they are often forgotten in the identification of vulnerable communities and not considered in relief programs (Platt et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

“…With respect to other conditions of public health significance, street-based sex workers have higher rates of HIV/STIs, substance use disorders, and mental health conditions (Bauermeister et al, 2017 ; Biello et al, 2014 ; Puri et al, 2017 ). This population also experiences a disproportionate number of social factors that affect health including trauma, poverty, homelessness, and substance use (Biello et al, 2014 ; Henny et al, 2007 ; Surratt & Inciardi, 2004 ; Walters et al, 2020a ). For example, preliminary data from the state of Rhode Island and the country show increases in substance use severity across all substances and increases in overdoses and overdose-related deaths as a result of COVID-19 (Czeisler et al, 2020 ; Rhode Island Department of Health, 2020 ; Silva & Kelly, 2020 ); and, anecdotally, this has directly impacted the lives of sex workers since the start of COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Sex Workers and Syndemics: A Population Vulnerable to HIV and COVID-19

et al. 2021

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COVID-19 has disproportionately affected vulnerable populations across the U.S. Street-based sex workers are one vulnerable population whose health and impact of COVID-19 have been understudied to date. The goal of this study was to evaluate findings from a community needs assessment with street-based sex workers on impact of COVID-19 on health behaviors and social circumstances. A brief survey was developed at a community-based harm reduction and recovery services organization. Surveys were administered by peer specialists to street-based sex workers during street outreach in April and May 2020. A total of 46 surveys were analyzed. Many individuals reported continuing to do sex work and use substances during the COVID pandemic. Slightly more than a quarter of individuals ( n = 13; 28.3%) indicated using personal protective equipment while doing sex work and described challenges to using precautions when working with clients. Individuals had used marijuana ( n = 32, 71.1%), cocaine ( n = 17, 39.5%), prescription stimulants ( n = 9, 21.4%), methamphetamines ( n = 5, 11.9%), prescription opioids ( n = 12, 27.3%), street opioids ( n = 12, 27.3%), sedatives ( n = 11, 25.0%), hallucinogens ( n = 3, 6.8%), inhalants ( n = 3, 7.0%), or some other substance ( n = 4, 8.7%) in the past 30 days. About half (48.8%) reported that COVID-19 had a major impact on their lives. This study is among the first to characterize the impact of COVID-19 on street-based sex workers. From a public health standpoint, this group also represents a high-priority population given their vulnerability and close contact with others, which increases the potential for community spread.

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“…Research on the HIV pandemic has long established that HIV co-occurs with multiple intersecting epidemics, creating what Singer termed a syndemic (Singer & Clair, 2003). Individuals experiencing mental health and substance abuse problems, food insecurity, housing instability, and overall social marginalization are the most vulnerable to HIV, and HIV infection perpetuates these co-occurring conditions (Robinson et al, 2016;Walters et al, 2020;Turpin et al, 2020;. While the transmission of COVID-19 is, of course, markedly different from HIV, there needs to be heightened concern for communities most afflicted by poverty, high population density, barriers to physical distancing, and limited access to health care and other resources-these factors will amplify vulnerability to COVID-19.…”

Section: Hiv Infection Is Not An Isolated Unidimensional Disease Itmentioning

confidence: 99%

Social and behavioral health responses to COVID-19: lessons learned from four decades of an HIV pandemic

2020

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A Syndemic Model of Exchange Sex Among HIV-Positive Men Who Have Sex With Men

Cited by 32 publications

References 101 publications

“They look at us like junkies”: influences of drug use stigma on the healthcare engagement of people who inject drugs in New York City

“They look at us like junkies”: influences of drug use stigma on the healthcare engagement of people who inject drugs in New York City

Sex Workers and Syndemics: A Population Vulnerable to HIV and COVID-19

Social and behavioral health responses to COVID-19: lessons learned from four decades of an HIV pandemic

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