Importance of substance use and violence in psychosocial syndemics among women with and at-risk for HIV

ABSTRACT Women in the US continue to be affected by HIV through heterosexual contact. Sexual risk behaviors among women have been associated with a syndemic, or a mutually reinforcing set of conditions, including childhood sexual abuse (CSA), depression, substance use, violence, and financial hardship. Baseline data from a cohort of women with and at-risk for HIV (N = 620; 52% HIV+) were analyzed with Poisson regression to assess evidence for additive, independent and interactive effects among syndemic conditions in relation to reported sexual risk behaviors (e.g., unprotected and transactional sex) over the past 6 months, controlling for age and HIV status. The number of syndemic conditions was incrementally associated with more types of sexual risk behaviors. For example, women with all five syndemic conditions reported 72% more types of risk behaviors over 6 months, as compared to women without any syndemic conditions. Compared to women with no syndemic conditions, women with three syndemic conditions reported 34% more and women with one syndemic condition reported 13% more types of risk behaviors. Endorsing substance use in the past 6 months, reporting CSA, and experiencing violence as an adult were independently associated with 49%, 12%, and 8% more types of risk behaviors, respectively compared to women without these conditions. Endorsing both substance use and violence was associated with 27% more types of risk behaviors. These associations were not moderated by HIV status. Understanding specific relationships and interactions are needed to more effectively prioritize limited resources in addressing the psychosocial syndemic associated with sexual risk behavior among women with and at-risk for HIV. Our results identify interrelated psychosocial factors that could be targeted by intervention studies aiming to reduce high-risk sex in this population.

[1]  V. Frye,et al.  HIV Sexual Risk and Syndemics among Women in Three Urban Areas in the United States: Analysis from HVTN 906 , 2015, Journal of Urban Health.

[2]  S. Reisner,et al.  Poverty matters: contextualizing the syndemic condition of psychological factors and newly diagnosed HIV infection in the United States , 2014, AIDS.

[3]  An-Lin Cheng,et al.  A syndemic model of women incarcerated in community jails. , 2014, Public health nursing.

[4]  A. Gielen,et al.  The Impact of Intimate Partner Violence, Substance Use, and HIV on Depressive Symptoms Among Abused Low-Income Urban Women , 2013, Journal of interpersonal violence.

[5]  L. Brown.  Emerging Opportunities for Pharmacists to Improve Health Care for the Poor and Underserved , 2013, Journal of health care for the poor and underserved.

[6]  M. Singer,et al.  At special risk: Biopolitical vulnerability and HIV/STI syndemics among women , 2012 .

[7]  F. Altice,et al.  Substance abuse, violence, and HIV in women: a literature review of the syndemic. , 2011, Journal of women's health.

[8]  Jennifer I. Manuel,et al.  Relationship Power and Sexual Risk among Women in Community-Based Substance Abuse Treatment , 2009, Journal of Urban Health.

[9]  A. Minnis,et al.  Poverty, Gender Inequities, and Women's Risk of Human Immunodeficiency Virus/AIDS , 2008, Annals of the New York Academy of Sciences.

[10]  J. Walkup,et al.  The Impact of Mental Health and Substance Abuse Factors on HIV Prevention and Treatment , 2008, Journal of acquired immune deficiency syndromes.

[11]  B. Mustanski,et al.  Psychosocial health problems increase risk for HIV among urban young men who have sex with men: Preliminary evidence of a syndemic in need of attention , 2007, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[12]  Y. Lo,et al.  Disorders of glucose metabolism among HIV-infected women. , 2005, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[13]  Y. Lo,et al.  Menopause symptoms in HIV-infected and drug-using women , 2005, Menopause.

[14]  R. Rubinstein,et al.  Structural Violence and Racial Disparity in HIV Transmission , 2004, Journal of health care for the poor and underserved.

[15]  Merrill Singer,et al.  Syndemics and public health: reconceptualizing disease in bio-social context. , 2003, Medical anthropology quarterly.

[16]  T. Hart,et al.  Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. , 2003, American journal of public health.

[17]  C. Leukefeld,et al.  Women, sex, and HIV: social and contextual factors, meta-analysis of published interventions, and implications for practice and research. , 2002, Psychological bulletin.

[18]  N. El-Bassel,et al.  Psychological Distress and Intimate Physical and Sexual Abuse among Women in Methadone Maintenance Treatment Programs , 2002, Social Service Review.

[19]  J. Simoni,et al.  Sex trading and psychological distress among women on methadone. , 2001, Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors.

[20]  Pravin K. Trivedi,et al.  Regression Analysis of Count Data , 1998 .

[21]  Anke A. Ehrhardt,et al.  A Review of HIV Interventions for At-Risk Women , 1997, AIDS and Behavior.

[22]  M. Singer,et al.  A Dose of Drugs, a Touch of Violence, a Case of Aids: Conceptualizing the Sava Syndemic , 1996 .

[23]  L. Radloff.  The CES-D Scale , 1977 .

[24]  A. Cameron,et al.  Regression Analysis of Count Data: Author Index , 1998 .

[25]  N. El-Bassel,et al.  Sex trading and psychological distress among women recruited from the streets of Harlem. , 1997, American journal of public health.