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AIDS and Behavior
Published in: AIDS and Behavior 3/2017

01-03-2017 | Original Paper

Prospective Effects of a Syndemic on HIV and STI Incidence and Risk Behaviors in a Cohort of Young Men Who Have Sex with Men

Authors: Brian Mustanski, Gregory Phillips II, Daniel T. Ryan, Gregory Swann, Lisa Kuhns, Rob Garofalo

Published in: AIDS and Behavior | Issue 3/2017

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Abstract

Young men who have sex with men continue to be highly affected by HIV. To improve understanding of the role that multiple co-occurring health issues (i.e., syndemics) play in HIV acquisition, sophisticated modeling methods are needed. The purpose of this study was to use structural equation modeling to understand the structure of the syndemic and to test its longitudinal association with condomless anal sex. Data are from a longitudinal study of 450 YMSM. A primary syndemic component comprised of substance use, violence, and internalizing mental health factors significantly predicted the number of condomless anal sex partners in the full sample. Analyses exploring associations by race/ethnicity found a significant association among White YMSM, but not among Black or Latino YMSM. Higher-order factor modeling suggests these psychosocial factors form a syndemic in all racial/ethnic groups, but the syndemic, as conceptualized here, may be less relevant to racial/ethnic minority YMSM.
Literature
1.
CDC. Diagnoses of HIV infection in the United States and dependent areas, 2014. HIV Surveillance Report. 2015;26:1–123.
2.
Balaji AB, Bowles KE, Le BC, Paz-Bailey G, Oster AM, Group NS. High HIV incidence and prevalence and associated factors among young MSM, 2008. AIDS. 2013;27:269–78.CrossRef
3.
Mustanski B, Newcomb M, Du Bois SN, Garcia SC, Grov C. HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions. J Sex Res. 2011;48:218–53.CrossRefPubMedPubMedCentral
4.
Garofalo R, Hotton AL, Kuhns LM, Gratzer B, Mustanski B. Incidence of HIV infection and sexually transmitted infections and related risk factors among very young men who have sex with men. J Acquir Immune Defic Syndr. 2016;72:79–86.CrossRefPubMed
5.
Halkitis P, Kapadia F, Ompad D. Incidence of HIV infection in young gay, bisexual, and other YMSM: the P18 cohort study. J Acquir Immune Defic Syndr. 2015;69:466–73.CrossRefPubMedPubMedCentral
6.
Stall R, Duran L, Wisniewski SR, et al. Running in place: implications of HIV incidence estimates among urban men who have sex with men in the United States and other industrialized countries. AIDS Behav. 2009;13:615–29.CrossRefPubMedPubMedCentral
7.
Rosenberg E, Kelley C, O’Hara B, et al. Equal behaviors, unequal risks: the role of partner transmission potential in racial HIV disparities among men who have sex with men (MSM) in the US. International AIDS Conference. Washington, D.C., 2012
8.
Koblin BA, Mayer KH, Eshleman SH, et al. Correlates of HIV acquisition in a cohort of Black men who have sex with men in the United States: HIV prevention trials network (HPTN) 061. PLoS ONE. 2013;8:e70413.CrossRefPubMedPubMedCentral
9.
Hess K, Hu X, Lansky A, Mermin J, Hall HI. Estimating the lifetime risk of a diagnosis of HIV infection in the United States. Conference on Retroviruses and Opportunistic Infections (CROI). Boston, MA, 2016
10.
Millett GA, Flores SA, Peterson JL, Bakeman R. Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors. AIDS. 2007;21:2083–91.CrossRefPubMed
11.
Feldman MB. A critical literature review to identify possible causes of higher rates of HIV infection among young black and Latino men who have sex with men. J Natl Med Assoc. 2010;102:1206–21.CrossRefPubMed
12.
Millett GA, Peterson JL, Flores SA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. Lancet. 2012;380:341–8.CrossRefPubMed
13.
Maulsby C, Millett G, Lindsey K, et al. HIV among Black men who have sex with men (MSM) in the United States: a review of the literature. AIDS Behav. 2014;18:10–25.CrossRefPubMed
14.
Maulsby C, Jain K, Sifakis F, German D, Flynn CP, Holtgrave D. Individual-level and partner-level predictors of newly diagnosed HIV infection among Black and White men who have sex with men in Baltimore. AIDS Behav. 2015;19:909–17.CrossRefPubMed
15.
Sullivan PS, Rosenberg ES, Sanchez TH, et al. Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: a prospective observational cohort study. Ann Epidemiol. 2015;25:445–54.CrossRefPubMedPubMedCentral
16.
Garofalo R, Mustanski B, Johnson A, Emerson E. Exploring factors that underlie racial/ethnic disparities in HIV risk among young men who have sex with men. J Urban Health. 2010;87:318–23.CrossRefPubMedPubMedCentral
17.
Clerkin EM, Newcomb ME, Mustanski B. Unpacking the racial disparity in HIV rates: the effect of race on risky sexual behavior among Black young men who have sex with men (YMSM). J Behav Med. 2011;34:237–43.CrossRefPubMed
18.
Newcomb ME, Mustanski B. Racial differences in same-race partnering and the effects of sexual partnership characteristics on HIV Risk in MSM: a prospective sexual diary study. J Acquir Immune Defic Syndr. 2013;62:329–33.CrossRefPubMedPubMedCentral
19.
Mustanski B, Birkett M, Kuhns LM, Latkin CA, Muth SQ. The role of geographic and network factors in racial disparities in HIV among young men who have sex with men: an egocentric network study. AIDS Behav. 2015;19:1037–47.CrossRefPubMedPubMedCentral
20.
Mustanski B, Garofalo R, Herrick A, Donenberg G. 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. Ann Behav Med. 2007;34:37–45.CrossRefPubMedPubMedCentral
21.
Halkitis PN, Moeller RW, Siconolfi DE, Storholm ED, Solomon TM, Bub KL. Measurement model exploring a syndemic in emerging adult gay and bisexual men. AIDS Behav. 2013;17:662–73.CrossRefPubMedPubMedCentral
22.
Singer M. AIDS and the health crisis of the US urban poor; the perspective of critical medical anthropology. Soc Sci Med. 1994;39:931–48.CrossRefPubMed
23.
Singer M. A dose of drugs, a touch of violence and case of AIDS: conceptualizing the SAVA syndemic. Free Inq Creat Sociol. 1996;24:99–110.
24.
Stall R, Mills TC, Williamson J, et al. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. Am J Public Health. 2003;93:939–42.CrossRefPubMedPubMedCentral
25.
Ferlatte O, Hottes TS, Trussler T, Marchand R. Evidence of a syndemic among young Canadian gay and bisexual men: uncovering the associations between anti-gay experiences, psychosocial issues, and HIV risk. AIDS Behav. 2014;18:1256–63.CrossRefPubMed
26.
Parsons JT, Grov C, Golub SA. Sexual compulsivity, co-occurring psychosocial health problems, and HIV risk among gay and bisexual men: further evidence of a syndemic. Am J Public Health. 2012;102:156–62.CrossRefPubMedPubMedCentral
27.
Mimiaga M, Biello KB, Robertson AM, et al. High prevalence of multiple syndemic conditions associated with sexual risk behavior and HIV infection among a large sample of Spanish and Portuguese speaking men who have sex with men in Latin America. Arch Sex Behav. 2015;44:1869–78.CrossRefPubMed
28.
Wim VB, Christiana N, Marie L. Syndemic and other risk factors for unprotected anal intercourse among an online sample of Belgian HIV negative men who have sex with men. AIDS Behav. 2014;18:50–8.CrossRefPubMed
29.
Yu F, Nehl EJ, Zheng T, et al. A syndemic including cigarette smoking and sexual risk behaviors among a sample of MSM in Shanghai, China. Drug Alcohol Depend. 2013;132:265–70.CrossRefPubMedPubMedCentral
30.
Kurtz SP. Arrest histories of high-risk gay and bisexual men in Miami: unexpected additional evidence for syndemic theory. J Psychoact Drugs. 2008;40:513–21.CrossRef
31.
Mustanski B, Andrews R, Herrick A, Stall R, Schnarrs PW. A syndemic of psychosocial health disparities and associations with risk for attempting suicide among young sexual minority men. Am J Public Health. 2014;104:287–94.CrossRefPubMedPubMedCentral
32.
Newcomb ME, Birkett M, Corliss HL, Mustanski B. Sexual orientation, gender, and racial differences in illicit drug use in a sample of US high school students. Am J Public Health. 2014;104:304–10.CrossRefPubMedPubMedCentral
33.
34.
Birkett M, Espelage DL, Koenig B. LGB and questioning students in schools: the moderating effects of homophobic bullying and school climate on negative outcomes. J Youth Adolesc. 2009;38:989–1000.CrossRefPubMed
35.
King M, Semlyen J, Tai SS, et al. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry. 2008;8:70.CrossRefPubMedPubMedCentral
36.
Hightow-Weidman LB, Phillips G 2nd, Jones KC, et al. Racial and sexual identity-related maltreatment among minority YMSM: prevalence, perceptions, and the association with emotional distress. AIDS Patient Care STDS. 2011;25(Suppl 1):S39–45.CrossRefPubMed
37.
Bostwick WB, Meyer I, Aranda F, et al. Mental health and suicidality among racially/ethnically diverse sexual minority youths. Am J Public Health. 2014;104:1129–36.CrossRefPubMedPubMedCentral
38.
Phillips G 2nd, Hightow-Weidman LB, Fields SD, et al. Experiences of community and parental violence among HIV-positive young racial/ethnic minority men who have sex with men. AIDS Care. 2014;26:827–34.CrossRefPubMed
39.
Outlaw AY, Phillips G 2nd, Hightow-Weidman LB, et al. Age of MSM sexual debut and risk factors: results from a multisite study of racial/ethnic minority YMSM living with HIV. AIDS Patient Care STDS. 2011;25:S23–9.CrossRefPubMed
40.
Kubicek K, McNeeley M, Collins S. “Same-sex relationship in a straight world”: individual and societal influences on power and control in young men’s relationships. J Interpers Violence. 2014;30:83–109.CrossRefPubMed
41.
Wong CF, Weiss G, Ayala G, Kipke MD. Harassment, discrimination, violence, and illicit drug use among young men who have sex with men. AIDS Educ Prev. 2010;22:286–98.CrossRefPubMedPubMedCentral
42.
Dyer TP, Shoptaw S, Guadamuz TE, et al. Application of syndemic theory to black men who have sex with men in the Multicenter AIDS Cohort Study. J Urban Health. 2012;89:697–708.CrossRefPubMedPubMedCentral
43.
Mimiaga M, O’Cleirigh C, Biello KB, et al. The effect of psychosocial syndemic production on 4-year HIV incidence and risk behavior in a large cohort of sexually active men who have sex with men. J Acquir Immune Defic Syndr. 2015;68:329–36.CrossRefPubMedPubMedCentral
44.
Guadamuz TE, McCarthy K, Wimonsate W, et al. Psychosocial health conditions and HIV prevalence and incidence in a cohort of men who have sex with men in Bangkok, Thailand: evidence of a syndemic effect. AIDS Behav. 2014;18:2089–96.CrossRefPubMedPubMedCentral
45.
46.
Verdejo-García A, Lawrence AJ, Clark L. Impulsivity as a vulnerability marker for substance-use disorders: review of findings from high-risk research, problem gamblers and genetic association studies. Neurosci Biobehav Rev. 2008;32:777–810.CrossRefPubMed
47.
Patterson T, Semple S, Zians J, Strathdee S. Methamphetamine-using HIV-positive men who have sex with men: correlates of polydrug use. J Urban Health. 2005;82:i120.CrossRefPubMedPubMedCentral
48.
Semple SJ, Zians J, Grant I, Patterson TL. Methamphetamine use, impulsivity, and sexual risk behavior among HIV-positive men who have sex with men. J Addict Dis. 2006;25:105–14.CrossRefPubMed
49.
Lambert E, Normand J, Stall R, Aral S, Vlahov D. Introduction: new dynamics of HIV risk among drug-using men who have sex with men. J Urban Health. 2005;82:i1–8.CrossRefPubMedPubMedCentral
50.
Derefinko KJ, Peters JR, Eisenlohr-Moul TA, Walsh EC, Adams ZW, Lynam DR. Relations between trait impulsivity, behavioral impulsivity, physiological arousal, and risky sexual behavior among young men. Arch Sex Behav. 2014;43:1149–58.CrossRefPubMedPubMedCentral
51.
Charnigo R, Noar SM, Garnett C, Crosby R, Palmgreen P, Zimmerman RS. Sensation seeking and impulsivity: combined associations with risky sexual behavior in a large sample of young adults. J Sex Res. 2013;50:480–8.CrossRefPubMed
52.
Donohew L, Zimmerman R, Cuppa PS, Novakb S, Colonc S, Abella R. Sensation seeking, impulsive decision-making, and risky sex: implications for risk-taking and design of interventions. Personal Individ Differ. 2000;28:1079–91.CrossRef
53.
Stall R, Pollack L, Mills TC, et al. Use of antiretroviral therapies among HIV-infected men who have sex with men: a household-based sample of 4 major American cities. Am J Public Health. 2001;91:767–73.CrossRefPubMedPubMedCentral
54.
O’Leary A, Jemmott JB 3rd, Stevens R, Rutledge SE, Icard LD. Optimism and education buffer the effects of syndemic conditions on HIV status among African American men who have sex with men. AIDS Behav. 2014;18:2080–8.CrossRefPubMedPubMedCentral
55.
Oster AM, Johnson CH, Le BC, et al. Trends in HIV prevalence and HIV testing among young MSM: five United States cities, 1994–2011. AIDS Behav. 2014;3:S237–47.CrossRef
56.
CDC (Center for Disease Control and Prevention), HIV Surveillance Report, 2011. Atlanta, GA: 2013
57.
Burns MN, Ryan DT, Garofalo R, Newcomb ME, Mustanski B. Mental health disorders in young urban sexual minority men. J Adolesc Health. 2015;56:52–8.CrossRefPubMed
58.
Newcomb ME, Ryan DT, Greene GJ, Garofalo R, Mustanski B. Prevalence and patterns of smoking, alcohol use, and illicit drug use in young men who have sex with men. Drug Alcohol Depend. 2014;141:65–71.CrossRefPubMedPubMedCentral
59.
Mustanski B, Newcomb M, Garofalo R. Mental health of lesbian, gay, and bisexual youth: a developmental resiliency perspective. J Gay & Lesbian Soc Serv. 2011;23:204–25.CrossRef
60.
Phillips G 2nd, Magnus M, Kuo I, et al. Childhood sexual abuse and HIV-related risks among men who have sex with men in Washington, DC. Arch Sex Behav. 2014;43:771–8.CrossRefPubMed
61.
Heckathorn DD. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997;44:174–99.CrossRef
62.
Mustanski B, Johnson AK, Garofalo R, Ryan D, Birkett M. Perceived likelihood of using HIV pre-exposure prophylaxis medications among young men who have sex with men. AIDS Behav. 2013;17:2173–9.CrossRefPubMedPubMedCentral
63.
Newcomb ME, Ryan DT, Garofalo R, Mustanski B. The effects of sexual partnership and relationship characteristics on three sexual risk variables in young men who have sex with men. Arch Sex Behav. 2014;43:61–72.CrossRefPubMedPubMedCentral
64.
Kuhns LM, Kwon S, Ryan DT, Garofalo R, Phillips G 2nd, Mustanski BS. Evaluation of respondent-driven sampling in a study of Urban young men who have sex with men. J Urban Health. 2014;92:151–67.CrossRefPubMedCentral
65.
Mustanski B, Starks T, Newcomb ME. Methods for the design and analysis of relationship and partner effects on sexual health. Arch Sex Behav. 2014;43:21–33.CrossRefPubMedPubMedCentral
66.
Robins L, Cottler L, Bucholz K, Compton W, North CS, Rourke KM. Diagnostic Interview Schedule for DSM-IV. St Louis: Washington University School of Medicine, Department of Psychiatry; 2002.
67.
Ramirez-Valles J, Kuhns LM, Campbell RT, Diaz RM. Social integration and health: community involvement, stigmatized identities, and sexual risk in Latino sexual minorities. J Health Soc Behav. 2010;51:30–47.CrossRefPubMedPubMedCentral
68.
Kuhns LM, Vazquez R, Ramirez-Valles J. Researching special populations: retention of Latino gay and bisexual men and transgender persons in longitudinal health research. Health Educ Res. 2008;23:814–25.CrossRefPubMed
69.
Miller RS, Johnson JA, Johnson JK. Assessing the prevalence of unwanted childhood sexual experiences. J Psychol & Hum Sex. 1992;4:43–54.CrossRef
70.
Whiteside SP, Lyman DR. The Five Factor Model and impulsivity: using a structural model of personality to understand impulsivity. Personal Individ Differ. 2001;30:669–89.CrossRef
71.
Cyders MA, Smith GT, Spillane NS, Fischer S, Annus AM, Peterson C. Integration of impulsivity and positive mood to predict risky behavior: development and validation of a measure of positive urgency. Psychol Assess. 2007;19:107–18.CrossRefPubMed
72.
Schreiber JB, Nora A, Stage FK, Barlow EA, King J. Reporting structural equation modeling and confirmatory factor analysis results: a review. J Educ Res. 2006;99:323–37.CrossRef
73.
74.
Bryant FB, Satorra A. Principles and practice of scaled difference Chi square testing. Struct Equ Model-a Multidiscip J. 2012;19:372–98.CrossRef
75.
Tsai AC, Burns BF. Syndemics of psychosocial problems and HIV risk: a systematic review of empirical tests of the disease interaction concept. Soc Sci Med. 2015;139:26–35.CrossRefPubMedPubMedCentral
76.
77.
Millett GA, Peterson JL, Wolitski RJ, Stall R. Greater risk for HIV infection of black men who have sex with men: a critical literature review. Am J Public Health. 2006;96:1007–19.CrossRefPubMedPubMedCentral
78.
79.
Kelly JA, Amirkhanian YA, Seal DW, et al. Levels and predictors of sexual HIV risk in social networks of men who have sex with men in the Midwest. AIDS Educ Prev. 2010;22:483–95.CrossRefPubMedPubMedCentral
80.
Wohl AR, Galvan FH, Myers HF, et al. Do social support, stress, disclosure and stigma influence retention in HIV care for Latino and African American men who have sex with men and Womenw. AIDS Behav. 2011;15:1098–110.CrossRefPubMed
81.
Milner LA, Ham LS, Zamboanga BL. Adolescents misusing prescription drugs: who’s the riskiest users of them all? J Subst Use. 2014;19:68–74.CrossRef
82.
Leeman RF, Patock-Peckham JA, Hoff RA, et al. Perceived parental permissiveness toward gambling and risky behaviors in adolescents. J Behav Addict. 2014;3:115–23.CrossRefPubMedPubMedCentral
83.
84.
Dvorak RD, Lamis DA, Malone PS. Alcohol use, depressive symptoms, and impulsivity as risk factors for suicide proneness among college students. J Affect Disord. 2013;149:326–34.CrossRefPubMedPubMedCentral
85.
Kissinger P, Rice J, Farley T, et al. Application of computer-assisted interviews to sexual behavior research. Am J Epidemiol. 1999;149:950–4.CrossRefPubMed
Metadata
Title
Prospective Effects of a Syndemic on HIV and STI Incidence and Risk Behaviors in a Cohort of Young Men Who Have Sex with Men
Authors
Brian Mustanski
Gregory Phillips II
Daniel T. Ryan
Gregory Swann
Lisa Kuhns
Rob Garofalo
Publication date
01-03-2017
Publisher
Springer US
Published in
AIDS and Behavior / Issue 3/2017
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-016-1607-3

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