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HIV Sexual Risk and Syndemics among Women in Three Urban Areas in the United States: Analysis from HVTN 906

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Abstract

Limited data are available on the longitudinal occurrence of syndemic factors among women at risk for HIV infection in the USA and how these factors relate to sexual risk over time. HVTN 906 was a longitudinal study enrolling 799 HIV-uninfected women in three cities. Assessments were done at baseline, 6, 12, and 18 months to assess syndemic factors (low education, low income, unemployment, lack of health insurance, housing instability, substance use, heavy alcohol use, partner violence, incarceration) and sexual risk outcomes. For each sexual risk outcome, a GEE model was fit with syndemic factors or syndemic score (defined as sum of binary syndemics, ranging from 0 to 9), visit, study site, age and race/ethnicity as predictors to examine the multivariable association between syndemic factors and outcomes over time. Odds of unprotected sex while drunk or high were significantly higher when women reported lack of health insurance, substance and heavy alcohol use and partner violence. Housing instability, substance and heavy alcohol use, partner violence and recent incarceration were associated with higher odds of having multiple sexual partners. Odds of sex exchange were significantly higher in the presence of unemployment, housing instability, low education, lack of health insurance, substance and heavy alcohol use, partner violence and incarceration. Housing instability, substance and heavy alcohol use, and partner violence were significantly associated with higher odds of unprotected anal sex. Odds of having a recent STI were significantly higher when women reported housing instability and partner violence. There were significantly higher odds of the reporting of any risk outcomes during follow-up with higher syndemic score. This study highlights a group of women experiencing multiple poor social and health outcomes who need to be the focus of comprehensive interventions.

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Acknowledgments

The HVTN 906 study team would like to thank the study participants, community advisory board members, and the study site staff for their commitment to this study. This research was funded by the Division of AIDS, National Institute of Allergy and Infectious Disease, National Institutes of Health, grants 1UM1AI068614, 1UM1A1069470, 1UM1A1069554, 1UM1A1069534, 1UM1AI068635 and P30AI045008.

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Authors and Affiliations

  1. Laboratory of Infectious Disease Prevention, New York Blood Center, 310 E.67th Street, New York, NY, 10065, USA

    Beryl A. Koblin & Debbie Lucy

  2. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Shannon Grant, Hillary Superak, Brittany Sanchez, Tamra Madenwald, Gina Escamilia & Cecilia Morgan

  3. Laboratory of Social and Behavioral Sciences, New York Blood Center, New York, NY, USA

    Victoria Frye

  4. HIV Prevention Division, University of Pennsylvania, Philadelphia, PA, USA

    Debora Dunbar & Ian Frank

  5. Section of Infectious Diseases, University of Illinois at Chicago, Chicago, IL, USA

    Parrie Graham & Richard M. Novak

  6. Division of AIDS, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA

    Edith Swann

  7. Infectious Diseases Division, University of Pennsylvania, Philadelphia, PA, USA

    Ian Frank

Authors
  1. Beryl A. Koblin
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  2. Shannon Grant
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  3. Victoria Frye
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  4. Hillary Superak
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  5. Brittany Sanchez
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  6. Debbie Lucy
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  7. Debora Dunbar
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  8. Parrie Graham
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  9. Tamra Madenwald
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  10. Gina Escamilia
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  11. Edith Swann
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  12. Cecilia Morgan
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  13. Richard M. Novak
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  14. Ian Frank
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Correspondence to Beryl A. Koblin.

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Koblin, B.A., Grant, S., Frye, V. et al. HIV Sexual Risk and Syndemics among Women in Three Urban Areas in the United States: Analysis from HVTN 906. J Urban Health 92, 572–583 (2015). https://doi.org/10.1007/s11524-015-9944-5

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  • DOI: https://doi.org/10.1007/s11524-015-9944-5

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