Syndemic conditions associated with increased HIV risk in a global sample of men who have sex with men
- Glenn-Milo Santos1,2,
- Tri Do2,
- Jack Beck3,
- Keletso Makofane3,
- Sonya Arreola3,
- Thomas Pyun3,
- Pato Hebert3,
- Patrick A Wilson4,
- George Ayala3
- 1HIV Prevention, San Francisco Department of Public Health, San Francisco, California, USA
- 2Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- 3Global Forum on MSM and HIV, Oakland, California, USA
- 4Columbia University, Mailman School of Public Health, New York, New York, USA
- Correspondence to Dr Glenn-Milo Santos, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA;
- Received 10 August 2013
- Revised 17 November 2013
- Accepted 8 December 2013
- Published Online First 15 January 2014
Objective We evaluated the relationship among syndemic conditions (defined as a cluster of interconnected psychosocial health conditions), sexual behaviours and self-reported HIV infection in a global sample of men who have sex with men (MSM).
Methods We used generalised estimating equations logistic regression models with robust SEs to assess the relationships among cumulative number of syndemic conditions—including depression, substance use, violence, sexual stigma and homelessness—and unprotected anal intercourse (UAI) and HIV infection, while accounting for clustering within-country in a global cross-sectional survey of 3934 MSM across 151 countries.
Results We observed parallel, significant dose–response associations between the number of syndemic conditions and UAI, as well as number of syndemic conditions and HIV infection. Compared with participants without syndemics, the adjusted OR (aOR) for UAI among those with 1, 2 and 3 or more syndemic conditions were 1.44 (Bonferroni-adjusted 95% CI 1.23 to 1.68), 1.89 (1.51 to 2.36) and 2.03 (1.43 to 2.89), respectively. Compared with participants without syndemics, the aOR for HIV infection among those with 1, 2 and 3 or more syndemic conditions were 1.67 (1.24 to 2.26), 2.02 (1.44 to 2.85) and 2.35 (1.31 to 4.21), respectively.
Conclusions This analysis provides evidence of intertwining syndemics that may operate synergistically to increase HIV risk among MSM globally. To curb HIV effectively and advance the health of MSM, multiple conditions must be addressed concurrently using multi-level approaches that target both individual and structural risk factors.