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The Effect of Psychosocial Syndemic Production on 4-Year HIV Incidence and Risk Behavior in a Large Cohort of Sexually Active Men Who Have Sex With Men

Year: 2014
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Cross-sectional studies have suggested that co-occurring epidemics or "syndemics" of psychosocial health problems may accelerate HIV transmission among men who have sex with men (MSM) in the United States. We aimed to assess how 5 syndemic conditions (depressive symptoms, heavy alcohol use, stimulant use, polydrug use, and childhood sexual abuse) affected HIV incidence and sexual risk behavior over time. METHODS: Eligible men in a large prospective cohort of sexually active HIV-uninfected MSM completed HIV testing and behavioral surveys at baseline and every 6 months for 48 months. We examined interrelationships between psychosocial problems and whether these interactions increased the odds of HIV risk behaviors and risk of seroconversion over study follow-up. RESULTS: Among 4295 men, prevalence of psychosocial conditions was substantial at baseline and was positively associated with each other. We identified a statistically significant positive dose-response relationship between numbers of syndemic conditions and HIV seroconversion for all comparisons (with the greatest hazard among those with 4-5 conditions, adjusted hazard ratio = 8.69; 95% confidence interval: 4.78 to 15.44). The number of syndemic conditions also predicted increased HIV-related risk behaviors over time, which mediated the syndemic-HIV seroconversion association. CONCLUSIONS: The accumulation of syndemic psychosocial problems predicted HIV-related sexual risk behaviors and seroconversion in a large sample of US MSM. Given the high prevalence of syndemic conditions among MSM and the moderate effect sizes attained by traditional brief behavioral interventions to date, the HIV prevention agenda requires a shift toward improved assessment of psychosocial comorbidities and stronger integration with mental health and substance abuse treatment services.
DOI: 10.1097/qai.0000000000000475
Authors: Matthew J. Mimiaga, Conall O'Cleirigh, Katie B. Biello, Angela M. Robertson, Steven A. Safren, Thomas J. Coates, Beryl A. Koblin, Margaret A. Chesney, Deborah J. Donnell, Ron D. Stall, Kenneth H. Mayer
Institutions: Beth Israel Deaconess Medical Center, New York Blood Center, Harvard University, University of California, Los Angeles, University of California, San Francisco, Massachusetts General Hospital, Fred Hutch Cancer Center, Fenway Health, University of Pittsburgh
Language: English
Subfield: Epidemiology
Field: Medicine
Open Access status: green
Awards: STATISTICAL &CLINICAL COORDINATING CENTER (SC), THE ZIMBABWE-SAN FRANCISCO HIV PREVENTION TRIALS UNIT, G1190522273, HIV PREVENTION TRIALS NETWORK LEADERSHIP GROUP, G1343089328, DOMESTIC MASTER CONTRACT FOR HIV VACCINE EFFICACY TRIALS, G2274702416, G2358511323, Behavioral Activation and HIV Risk Reduction for MSM with Crystal Meth Abuse, G2934770447, G3416789756, STDS AND HETEROSEXUAL 'BRIDGING'AMONG MEN WHO HAVE SEX, HIV PREVENTION TRIAL UNIT (PRIDE NYC PROGRAM), HIV Prevention and Trauma Treatment for MSM with Childhood Sexual Abuse Histories, HIV PREVENTION TRIAL UNITS, G784132205, G807554087, HIV Prevention Trials Network Leadership and Operations Center, Center for HIV Identification, Prevention and Treatment Services, SDMC: HIV Prevention Trials Network, G903806230
OpenAlex ID: W1965014075
FWCI: 14.9
Cites: 29
Cited by: 201
Related to: 10