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Prospective Effects of a Syndemic on HIV and STI Incidence and Risk Behaviors in a Cohort of Young Men Who Have Sex with Men

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Abstract

Young men who have sex with men continue to be highly affected by HIV. To improve understanding of the role that multiple co-occurring health issues (i.e., syndemics) play in HIV acquisition, sophisticated modeling methods are needed. The purpose of this study was to use structural equation modeling to understand the structure of the syndemic and to test its longitudinal association with condomless anal sex. Data are from a longitudinal study of 450 YMSM. A primary syndemic component comprised of substance use, violence, and internalizing mental health factors significantly predicted the number of condomless anal sex partners in the full sample. Analyses exploring associations by race/ethnicity found a significant association among White YMSM, but not among Black or Latino YMSM. Higher-order factor modeling suggests these psychosocial factors form a syndemic in all racial/ethnic groups, but the syndemic, as conceptualized here, may be less relevant to racial/ethnic minority YMSM.

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Funding

Data collection for this study was funded by the National Institute on Drug Abuse (R01DA025548). Analyses and manuscript preparation were supported by a grant from the National Institute on Drug Abuse (U01DA036939). We acknowledge the support of the Third Coast Center for AIDS Research (CFAR), an NIH funded center (P30AI117943). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Drug Abuse or the National Institutes of Health.

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Authors and Affiliations

  1. Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Brian Mustanski, Gregory Phillips II, Daniel T. Ryan & Gregory Swann

  2. Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 2700, Chicago, IL, 60611, USA

    Brian Mustanski, Gregory Phillips II, Daniel T. Ryan & Gregory Swann

  3. Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Lisa Kuhns & Rob Garofalo

  4. Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Lisa Kuhns & Rob Garofalo

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  1. Brian Mustanski
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  2. Gregory Phillips II
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Correspondence to Brian Mustanski.

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Brian Mustanski declares that he has no conflict of interest. Gregory Phillips declares that he has no conflict of interest. Daniel Ryan declares that he has no conflict of interest. Gregory Swann declares that he has no conflict of interest. Lisa Kuhns declares that she has no conflict of interest. Rob Garofalo declares that he has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Mustanski, B., Phillips, G., Ryan, D.T. et al. Prospective Effects of a Syndemic on HIV and STI Incidence and Risk Behaviors in a Cohort of Young Men Who Have Sex with Men. AIDS Behav 21, 845–857 (2017). https://doi.org/10.1007/s10461-016-1607-3

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