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Intersecting Relationships of Psychosocial and Structural Syndemic Problems Among People with HIV in South Africa: Using Network Analysis to Identify Influential Problems

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Abstract

In South Africa, little is known about interrelationships between syndemic problems among people with HIV (PWH). A better understanding of syndemic problems may yield important information regarding factors amenable to mitigation. We surveyed 194 PWH in Khayelitsha, outside of Cape Town, South Africa. We used network analysis to examine the frequency of 10 syndemic problems and their interrelationships. Syndemic problems among PWH in South Africa were common; 159 (82.8%) participants reported at least 2 co-occurring syndemic problems and 90 (46.9%) endorsed 4 or more. Network analysis revealed seven statistically significant associations. The most central problems were depression, substance use, and food insecurity. Three clusters of syndemics were identified: mood and violence; structural factors; and behavioral factors. Depression, substance use, and food insecurity commonly co-occur among PWH in sub-Saharan Africa and interfere with HIV outcomes. Network analysis can identify intervention targets to potentially improve HIV treatment outcomes.

Resumen

En Sudáfrica, poco se sabe sobre interrelaciones entre problemas sindémicos entre personas con VIH (PCV). Un major entendimiento de los problemas sindémicos puede arrojar información importante sobre los factores susceptibles de mitigación. Utilizamos el análisis de redes para examinar la frecuencia de 10 problemas sindémicos y sus interrelaciones. Problemas sindémicos entre PCV en Sudáfrica eran communes; 159 (82.8%) participantes presentaron al menos 2 problemas sindémicos concurrentes y 90 (46.9%) presentaron 4 o más. El análisis de red reveló siete asociaciones estadísticamente significativas. Los problemas más centrales fueron la depresión, el uso de sustancias y la inseguridad alimentaria. Se indetificaron tres grupos de sindemias: estado de ánimo y violencia; factores estructurales; y factores de comportamiento. La depresión, el uso de sustancias y la inseguridad alimentaria comúnmente ocurren simultáneamente entre las PCV en el África subsahariana e interfieren con los resultados del VIH. El análisis de redes puede identificar objetivos de intervención para potencialmente mejorar los resultados del tratamiento del VIH.

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Data are available upon request to the corresponding author.

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Acknowledgements

Funding for this project came from the National Institute of Mental Health F31MH122279 (Lee) and R01MH103770 (Safren, O’Cleirigh). Some additional support was from P30MH116867 (Safren), K24DA040489 (Safren), and Dr. Lee’s time on this manuscript was supported by T32MH116140 (Henderson, Fricchione). Dr. Magidson’s time on this manuscript was supported by K23DA041901 (Magidson). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health, the National Institute of Drug Abuse, or the National Institutes of Health, or any of the other funders. Data were collected in public primary care clinics in Khayelitsha outside of Cape Town, South Africa. We would like to thank the City of Cape Town Health Department for allowing us access to their clinics and for their ongoing support. We would also like to thank the clinic staff and study participants for their time spent on the project, as well as the study team who worked tirelessly on this project. Special thanks to Nicolas Cardenas for translating the Abstract into Spanish.

Funding

Funding for this project came from the National Institute of Mental Health F31MH122279 (Lee) and R01MH103770 (Safren, O’Cleirigh). Some additional support was from P30MH116867 (Safren), K24DA040489 (Safren), and T32MH116140 (Henderson, Fricchione). Dr. Magidson’s time on this manuscript was supported by K23DA041901 (Magidson). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health, the National Institute of Drug Abuse, or the National Institutes of Health, or any of the other funders.

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Authors and Affiliations

  1. Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Sq, 7th Floor, Boston, MA, 02114, USA

    Jasper S. Lee & Conall O’Cleirigh

  2. Department of Psychiatry, Harvard Medical School, Boston, MA, USA

    Jasper S. Lee & Conall O’Cleirigh

  3. Department of Psychology, University of Miami, Coral Gables, FL, USA

    Sierra A. Bainter & Steven A. Safren

  4. Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA

    Alexander C. Tsai

  5. Harvard Medical School, Boston, MA, USA

    Alexander C. Tsai

  6. Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

    Lena S. Andersen

  7. Department of Psychology, Boston University, Boston, MA, USA

    Amelia M. Stanton

  8. Department of Psychology, University of Maryland, College Park, MD, USA

    Jessica F. Magidson

  9. Department of Psychology, Stellenbosch University, Stellenbosch, Western Cape, South Africa

    Ashraf Kagee

  10. HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa

    John A. Joska

Authors
  1. Jasper S. Lee
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  2. Sierra A. Bainter
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  3. Alexander C. Tsai
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  4. Lena S. Andersen
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  5. Amelia M. Stanton
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  6. Jessica F. Magidson
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  7. Ashraf Kagee
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  8. John A. Joska
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  9. Conall O’Cleirigh
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  10. Steven A. Safren
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Contributions

JSL, SAS, JAJ, and COC formulated the research questions, SAS, CO, and JAJ designed the study, LSA, JSL, AMS, AK, JFM, JAJ, COC, and SAS carried out the study, JSL analyzed the data, SAB provided statistical consultation, ACT provided conceptual consultation, and all authors contributed to the writing of the manuscript.

Corresponding author

Correspondence to Jasper S. Lee.

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Ethical approval and consent to participate

All study procedures were approved by the University of Miami institutional review board and the University of Cape Town ethics committee. All participants completed the informed consent process prior to participation.

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Not applicable.

Competing interests

Dr. Safren receives royalties for books published by Oxford University Press, Springer/Humana Press, and Guilford Publications.

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Lee, J.S., Bainter, S.A., Tsai, A.C. et al. Intersecting Relationships of Psychosocial and Structural Syndemic Problems Among People with HIV in South Africa: Using Network Analysis to Identify Influential Problems. AIDS Behav 27, 1741–1756 (2023). https://doi.org/10.1007/s10461-022-03906-z

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