Exploring Psychosocial and Structural Syndemic Effects as Predictors of HIV Risk Behaviors Among Black Women (HPTN 064)
Publication: Journal of Women's Health
Abstract
Background: Syndemic models have been used in previous studies exploring HIV-related outcomes; however, these models do not fully consider intersecting psychosocial (e.g., substance use, depressive symptoms) and structural factors (unstable housing, concentrated housing vacancy) that influence the lived experiences of women. Therefore, there is a need to explore the syndemic effects of psychosocial and structural factors on HIV risk behaviors to better explain the multilevel factors shaping HIV disparities among black women.
Methods: This analysis uses baseline data (May 2009–August 2010) from non-Hispanic black women enrolled in the HIV Prevention Trials Network 064 Women’s Seroincidence Study (HPTN 064) and the American Community Survey 5-year estimates from 2007 to 2011. Three parameterizations of syndemic factors were applied in this analysis a cumulative syndemic index, three syndemic groups reflecting the level of influence (psychosocial syndemic group, participant-level structural syndemic group, and a neighborhood-level structural syndemic group), and syndemic factor groups. Clustered mixed effects log-binomial analyses measured the relationship of each syndemic parameterization on HIV risk behaviors in 1,347 black women enrolled in HPTN 064.
Results: A higher syndemic score was significantly associated with increased prevalence of unknown HIV status of the last male sex partner (adjusted prevalence ratio (aPR) = 1.07, 95% confidence interval or CI 1.04–1.10), involvement in exchange sex (aPR = 1.17, 95% CI: 1.14–1.20), and multiple sex partners (aPR = 1.07, 95% CI: 1.06–1.09) in the last 6 months. A dose–response relationship was observed between the number of syndemic groups and HIV risk behaviors, therefore, being in multiple syndemic groups was significantly associated with increased prevalence of reporting HIV risk behaviors compared with being in one syndemic group. In addition, being in all three syndemic groups was associated with increased prevalence of unknown HIV status of the last male sex partner (aPR = 1.67, 95% CI: 1.43–1.95) and multiple sex partners (aPR = 1.53, 95% CI: 1.36–1.72).
Conclusions: Findings highlight syndemic factors influence the lived experiences of black women.
Get full access to this article
View all available purchase options and get full access to this article.
References
1. Centers for Disease Control and Prevention (CDC). NCHHSTP AtlasPlus. Atlanta, GA; 2022. Available from: https://www.cdc.gov/nchhstp/atlas/ [Last accessed: November 7, 2023].
2. Meyer JP, Springer SA, Altice FL. Substance abuse, violence, and HIV in women: A literature review of the syndemic. J Womens Health 2011;20(7):991–1006;
3. Koblin BA, 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 2015;92(3):572–583;
4. Peasant C, Sullivan TP, Weiss NH, et al. Beyond the syndemic: Condom negotiation and use among women experiencing partner violence. AIDS Care 2016;29(4):516–523;
5. Nehl EJ, Klein H, Sterk CE, et al. Prediction of HIV sexual risk behaviors among disadvantaged African American adults using a syndemic conceptual framework. AIDS Behav 2015;20(2):449–460;
6. Brawner BM, Kerr J, Castle BF, et al. A systematic review of neighborhood-level influences on HIV vulnerability. AIDS Behav 2022;26(3):874–934;
7. Brown LK, Tolou-Shams M, Lescano C, et al. Depressive symptoms as a predictor of sexual risk among African American adolescents and young adults. J Adolesc Health 2006;39(3):444.e1–8–444.e8;
8. Lehrer JA, Shrier LA, Gortmaker S, et al. Depressive symptoms as a longitudinal predictor of sexual risk behaviors among US middle and high school students. Pediatrics 2006;118(1):189–200;
9. Richter L, Komárek A, Desmond C, et al. Reported physical and sexual abuse in childhood and adult HIV risk behaviour in three African countries: Findings from project accept (HPTN-043). AIDS Behav 2013;18(2):381–389;
10. Cohen M, Deamant C, Barkan S, et al. Domestic violence and childhood sexual abuse in HIV-infected women and women at risk for HIV. Am J Public Health 2000;90(4):560–565;
11. Wu E, El-Bassel N, Witte SS, et al. Intimate partner violence and HIV risk among urban minority women in primary health care settings. AIDS Behav 2003;7(3):291–301;
12. Bensley LS, Van Eenwyk J, Simmons KW. Self-reported childhood sexual and physical abuse and adult HIV-risk behaviors and heavy drinking. Am J Prev Med 2000;18(2):151–158;
13. Wingood GM, DiClemente RJ. Child sexual abuse, HIV sexual risk, and gender relations of African-American women. Am J Prev Med 1997;13(5):380–384.
14. Gielen AC, McDonnell KA, O’Campo PJ. Intimate partner violence, HIV status, and sexual risk reduction. AIDS and Behavior 2002;6(2):107–116.
15. Centers for Disease Control and Prevention. Social determinants of health among adults with diagnosed HIV infection in the United States and Puerto Rico, 2021. HIV Surveillance Supplemental Report 2023;28(5); 2023. Available from: http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html [Last accessed: October, 2023].
16. Hodder SL, Justman J, Hughes JP, et al. HIV acquisition among women from selected areas of the United States: A cohort study. Ann Intern Med 2013;158(1):10–18;
17. Fasula AM, Fogel CI, Gelaude D, et al. Project power: Adapting an evidence-based HIV/STI prevention intervention for incarcerated women. AIDS Educ Prev 2013;25(3):203–215;
18. Singer M, Clair S. Syndemics and public health: Reconceptualizing disease in bio-social context. Med Anthropol Q 2003;17(4):423–441;
19. Singer MC, Erickson PI, Badiane L, et al. Syndemics, sex and the city: Understanding sexually transmitted diseases in social and cultural context. Soc Sci Med 2006;63(8):2010–2021;
20. Singer M. AIDS and the health crisis of the US urban poor; the perspective of critical medical anthropology. Soc Sci Med 1994;39(7):931–948;
21. Godley BA, Adimora AA. Syndemic theory, structural violence and HIV among African–Americans. Curr Opin HIV AIDS 2020;15(4):250–255;
22. Sullivan KA, Messer LC, Quinlivan EB. Substance abuse, violence, and HIV/AIDS (SAVA) syndemic effects on viral suppression among HIV positive women of color. AIDS Patient Care STDS 2015;29 Suppl 1(Suppl 1):S42–8;
23. Illangasekare S, Burke J, Chander G, et al. The syndemic effects of intimate partner violence, HIV/AIDS, and substance abuse on depression among low-income urban women. J Urban Health 2013;90(5):934–947;
24. Senn TE, Carey MP, Vanable PA. The intersection of violence, substance use, depression, and STDs: Testing of a syndemic pattern among patients attending an urban STD clinic. J Natl Med Assoc 2010;102(7):614–620;
25. Gielen AC, Ghandour RM, Burke JG, et al. HIV/AIDS and intimate partner violence: Intersecting women’s health issues in the United States. Trauma Violence Abuse 2007;8(2):178–198;
26. Kuhns LM, Hotton AL, Garofalo R, et al. An index of multiple psychosocial, syndemic conditions is associated with antiretroviral medication adherence among HIV-positive youth. AIDS Patient Care STDS 2016;30(4):185–192;
27. Turpin R, Slopen N, Boekeloo B, et al. Testing a syndemic index of psychosocial and structural factors associated with HIV testing among black men. J Health Care Poor Underserved 2020;31(1):455–470;
28. Friedman MR, Stall R, Silvestre AJ, et al. Effects of syndemics on HIV viral load and medication adherence in the multicentre AIDS cohort study. AIDS 2015;29(9):1087–1096;
29. The HIV Prevention Trials Network [Internet]. Available from: https://www.hptn.org/research/studies/hptn064 [Last accessed: October 29, 2023].
30. Semaan S, Lauby J, Liebman J. Street and network sampling in evaluation studies of HIV risk-reduction interventions. AIDS Rev 2002;4(4):213–223.
31. U.S. Census Bureau. American Community Survey Information Guide. Washington, DC; 2017. Available from: https://www.census.gov/content/dam/Census/programs-surveys/acs/about/ACS_Information_Guide.pdf [Last accessed: October 29, 2023].
32. Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement 1977;1(3):385–401.
33. DiClemente RJ, Wingood GM, Crosby RA, et al. A prospective study of psychological distress and sexual risk behavior among black adolescent females. Pediatrics 2001;108(5):e85;
34. Cameron RP, Gusman D. The primary care PTSD screen (PC-PTSD): development and operating characteristics. Primary Care Psychiatry 2003;9(1):9–14.
35. Stoner MC, Haley DF, Golin CE, et al. The relationship between economic deprivation, housing instability and transactional sex among women in North Carolina (HPTN 064). AIDS Behav 2019;23(11):2946–2955;
36. Haley DF, Lucas J, Golin CE, et al. Retention strategies and factors associated with missed visits among low income women at increased risk of HIV acquisition in the US (HPTN 064). AIDS Patient Care STDS 2014;28(4):206–217;
37. Golin CE, Haley DF, Wang J, et al. Post-traumatic stress disorder symptoms and mental health over time among low-income women at increased risk of HIV in the US. J Health Care Poor Underserved 2016;27(2):891–910;
38. WHO ASSIST Working Group. The alcohol, smoking and substance involvement screening test (ASSIST): development, reliability and feasibility. Addiction 2002;97(9):1183–1194.
39. Fernald M. America’s rental housing: Evolving markets and needs. Joint Center for Housing Studies of Harvard University, Cambridge, MA. 2013. Available from: https://www.jchs.harvard.edu/sites/default/files/jchs_americas_rental_housing_2013_1_0.pdf
40. Ransome Y, Kawachi I, Braunstein S, et al. Structural inequalities drive late HIV diagnosis: The role of black racial concentration, income inequality, socioeconomic deprivation, and HIV testing. Health Place 2016;42:148–158;
41. Jennings L, Rompalo AM, Wang J, et al. Prevalence and correlates of knowledge of male partner HIV testing and serostatus among African-American women living in high poverty, high HIV prevalence communities (HPTN 064). AIDS Behav 2015;19(2):291–301;
42. Bedoya CA, Mimiaga MJ, Beauchamp G, et al. Predictors of HIV transmission risk behavior and seroconversion among Latino men who have sex with men in Project EXPLORE. AIDS Behav 2012;16(3):608–617;
43. Mimiaga MJ, Hughto JM, Biello KB, et al. Longitudinal analysis of syndemic psychosocial problems predicting HIV risk behavior among a multicity prospective cohort of sexually active young transgender women in the United States. J Acquir Immune Defic Syndr2019;81(2):184–192;
44. Cook JA, Burke-Miller JK, Steigman PJ, et al. Prevalence, comorbidity, and correlates of psychiatric and substance use disorders and associations with HIV risk behaviors in a multisite cohort of women living with HIV. AIDS Behav 2018;22(10):3141–3154;
45. Carrieri MP, Leport C, Protopopescu C, et al. Factors associated with nonadherence to highly active antiretroviral therapy: A 5-year follow-up analysis with correction for the bias induced by missing data in the treatment maintenance phase. J Acquir Immune Defic Syndr 2006;41(4):477–485;
46. Haley DF, Haardörfer R, Kramer MR, et al. Associations between neighborhood characteristics and sexual risk behaviors among HIV-infected and HIV-uninfected women in the southern United States. Ann Epidemiol 2017;27(4):252–259.e1;
47. Martinez O, Arreola S, Wu E, et al. Syndemic factors associated with adult sexual HIV risk behaviors in a sample of Latino men who have sex with men in New York City. Drug Alcohol Depend 2016;166:258–262;
48. Parsons JT, Antebi-Gruszka N, Millar BM, et al. Syndemic conditions, HIV transmission risk behavior, and transactional sex among transgender women. AIDS Behav 2018;22(7):2056–2067;
Information & Authors
Information
Published In
Journal of Women's Health
Copyright
Copyright 2024, Mary Ann Liebert, Inc., publishers.
History
Published online: 19 March 2024
Topics
Authors
Author’s Contribution
T.D.: Conceptualization (supporting); Writing—review and editing (equal). D.H.: Conceptualization (supporting); Writing—review and editing (equal). T.M.: Writing—review and editing (equal). M.M.: Writing—review and editing (equal). Q.N.: Writing—review and editing (equal). R.T.: Methodology (supporting); Writing—review and editing (equal). L.W.: Conceptualization (lead); Data Curation (lead); Formal Analysis (lead); Methodology (lead); Visualization (lead); Writing—original draft preparation (lead); Writing—review and editing (equal).
Author Disclosure Statement
No competing financial interests exist.
Funding Information
Overall support for the HPTN is provided by the National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), National Institute on Drug Abuse (NIDA), the National Institute of Mental Health (NIMH) under Award Numbers UM1AI068619. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Metrics & Citations
Metrics
Citations
Export Citation
Export citation
Select the format you want to export the citations of this publication.
View Options
Get Access
Access content
To read the fulltext, please use one of the options below to sign in or purchase access.⚠ Society Access
If you are a member of a society that has access to this content please log in via your society website and then return to this publication.