The application of a syndemic framework in exploring race related HIV disparities and vulnerabilities among men who have sex with men in Atlanta, Georgia
Stevens, Thomas L
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INTRODUCTION: Since the beginning of the epidemic in the United States, HIV/AIDS has severely affected men who have sex with men (MSM). Black MSM continue to be disproportionately affected by the epidemic. The syndemic framework offers an innovative approach to understanding the relationship between HIV risk factors and the trajectory of HIV infection in MSM. PURPOSE: The dissertation examined the relationship between biopsychosocial risk factors, the association between HIV risk factors and respective HIV outcomes, and the relationship between the syndemic risk scores and HIV outcomes, in respect to race for MSM in Atlanta, Georgia. METHODS: Secondary data analysis was conducted on data derived from the NHBS-MSM 4th cycle (2014). The Chi-square (Χ2) and one-way analysis of variance (ANOVA) tests determined the differences in the proportion of select variables. Multivariate analyses tested the association between syndemic risk scores and race and the association between syndemic risks scores and defined HIV outcomes by race. RESULTS: There were no significant differences in syndemic risk scores by race (p < 0.05). The mean syndemic risk scores were .68 to 2.96 units higher for Black MSM and 1.93 to 6.84 units higher for Other MSM compared to White MSM (p < 0.05). The PCA (p = 0.004) and Literature Informed (p= 0.012) Weighted Syndemic Risk Scores were associated with HIV positive status. There were no differences by race in the association between syndemic risks scores and HIV outcomes. CONCLUSION: There was a co-occurrence of multiple biopsychosocial risk factors for HIV infection across races. The odds of HIV infection and unprotected insertive anal intercourse (UIAI) increased by as much as 2.4 and 1.7 times per unit increment in syndemic risk score, respectively. Black MSM were associated with elevated odds of HIV positive status but lower odds of unprotected receptive anal intercourse (URAI). There was no significant difference by race and the association between syndemic risks scores and HIV outcomes. The convergence of biopsychosocial risk factors increases HIV outcomes beyond the individual risk of these factors. Researchers, practitioners, and policy makers must develop new approaches (e.g., syndemic) to addressing health disparities in the MSM population.