Adversity and Syndemic Production Among Men Participating in the Multicenter AIDS Cohort Study: A Life-Course Approach

Abstract

Objectives We tested a theory of syndemic production among men who have sex with men (MSM) using data from a large cohort study. Methods Participants were 1551 men from the Multicenter AIDS Cohort Study enrolled at 4 study sites: Baltimore, Maryland–Washington, DC; Chicago, Illinois; Los Angeles, California; and Pittsburgh, Pennsylvania. Participants who attended semiannual visits from April 1, 2008, to March 31, 2009, completed an additional survey that captured data about events throughout their life course thought to be related to syndemic production. Results Using multivariate analysis, we found that the majority of life-course predictor variables (e.g., victimization, internalized homophobia) were significantly associated with both the syndemic condition and the component psychosocial health outcomes (depressive symptoms, stress, stimulant use, sexual compulsivity, intimate partner violence). A nested negative binomial analysis showed that the overall life course significantly explained variability in the syndemic outcomes (χ2 = 247.94; P < .001; df = 22). Conclusions We identified life-course events and conditions related to syndemic production that may help to inform innovative interventions that will effectively disentangle interconnecting health problems and promote health among MSM.

Resilience as a Research Framework and as a Cornerstone of Prevention Research for Gay and Bisexual Men: Theory and Evidence

“…A clear example would be that a low level of HIV prevalence, such as was seen in many locales early in the epidemic, is associated with low levels of transmission regardless of any other factor. More to the point of this discussion, it is well documented that experiences of adversity are associated with increases in co-occurring psychosocial health problems (syndemics) [18], and syndemics are in turn associated with HIV risk [19], HIV prevalence [7], and HIV incidence [20]. As demonstrated in Fig.…”

Thriving and Adapting: Resilience, Sense of Community, and Syndemics among Young Black Gay and Bisexual Men

“…Indeed, a long-lingering paradox of the high rates of infection among Black GBM remains: they consistently report less risk behavior than their non-Black counterparts (Feldman, 2010;Millett, Flores, Peterson & Bakeman, 2007).The largely unwritten story is that even though Black GBM contend with a multitude of social stressors, a sizable number of GBM must have reservoirs of resilience to mitigate and withstand negative sexual and psychosocial health outcomes. Despite the call for a resilience-based approach to the study of syndemics (Herrick et al, 2011;Wilson et al, 2014), the empirical syndemics literature continues to focus on the identification of risk factors that make men vulnerable to syndemics (Dyer et al, 2012;Egan et al, 2011;Herrick et al, 2012Herrick et al, , 2014. Inquiry examining sources of GBM's resilience remains limited.…”

“…Yet much of the empirical literature has avoided assessing how location may affect syndemics or the experience of syndemics. In empirical studies, samples are often compiled across varied locations (Dyer et al, 2012;Herrick et al, 2012;Stall et al, 2003). It is likely that these locations influence susceptibility to syndemics.…”

Sexual Minority Status and Violence Among HIV Infected and At-Risk Women

“…[52][53][54] Childhood sexual abuse also emerged as an important predictor of abuse; this is in line with previous studies, which found that women abused as children were twice as likely to experience violence as adults, 4 and may support the importance of early interventions. 55 There are several limitations to this study. Sexual identity was asked only at baseline; women, especially sexual minorities, often change their identity over time, potentially leading to misclassification.…”