An Exploration of Syndemic Factors That Influence Engagement in HIV Care Among Black Men

Abstract

Syndemic theory seeks to understand the interactions and clustering of disease and social conditions and explain racial disparities in HIV. Traditionally applied to HIV risk, this study characterizes the syndemic challenges of engagement in care among Black men living with HIV and provides insight into potential HIV treatment interventions to retain vulnerable individuals in care. Interviews were conducted with 23 HIV-positive men who were either out-of-care or non-adherent to antiretroviral therapy. Interviews were audio-recorded, transcribed verbatim, and coded using MAXQDA qualitative software. Researchers analyzed data using thematic content analysis to identify syndemic factors associated with disengagement in care or suboptimal ART adherence among Black men. Analyses revealed the syndemic nature of 4 themes: intersectional stigma, depression, substance use, and poverty. Findings from this study offer numerous opportunities for intervention including social and structural-level interventions to address syndemic processes and the influence of stigma and poverty on engagement in care.

Autonomy-Supportive Healthcare Climate and HIV-Related Stigma Predict Linkage to HIV Care in Men Who Have Sex With Men in Ghana, West Africa

“… 47 , 48 Ultimately, the connections among these different stigmas support the idea that MSM living with HIV experience intersecting (rather than independent) stigmatizations in their identities as gay, bisexual, queer, or gender nonconforming men living with HIV. 49 , 50 …”

“We Are Powerful People”: Health-Promoting Strengths of LGBTQ Communities of Color

“…LGBTQ people of color experience higher rates of being uninsured, delaying or avoiding health care, and delaying or not getting needed prescription medication compared with White and heterosexual counterparts (Krehely, 2009). Social-structural factors, including intersectional stigma and poverty, as well as individual influences, such as depression, are likely prominent barriers to engaging in health care among LGBTQ communities of color (Quinn, Reed, Dickson-Gomez, & Kelly, 2018; Romanelli & Hudson, 2017). Other individual-level health-adverse factors include behaviors (e.g., drug use), psychocognitive processes (e.g., stress), and biological factors (e.g., allostatic loads), as well as likelihoods of victimization, abuse, and discrimination based on intersecting social identities (e.g., gender identity/expression, sexual orientation, race/ethnicity, and socioeconomic status).…”

Health Care Providers’ Challenges to High-Quality HIV Care and Antiretroviral Treatment Retention in Rural South Africa

“…Social barriers reported in prior studies to affect individuals’ linkage to and retention in HIV care include HIV-related stigma; fear of disclosure; lack of social, family, or partner support; unequal gender norms; cultural and religious beliefs; and relocation and mobility (Govindasamy et al, 2012; Kelly et al, 2014; Kim et al, 2016; Lippman et al, 2017; Mill et al, 2013; Pulerwitz et al, 2019; Quinn et al, 2018; Shabalala et al, 2018). Key structural barriers reported include distance to the clinic, the cost of transportation, time to get to the clinic, wait times at clinics, lack of adherence counseling, and limited availability of support services, such as peer support groups, adolescent-friendly services, and Antenatal Care Services (Geng, Bangsberg, et al, 2010; Geng et al, 2016; Geng, Nash, et al, 2010; Govindasamy et al, 2014; Lamb et al, 2012; Losina et al, 2010; MacPherson et al, 2012; Roura et al, 2009; Scanlon & Vreeman, 2013; Tweya et al, 2018).…”