'Syndemic factors', defined as co-occurring psychological
conditions including major depressive disorder, substance and alcohol use, and
intimate partner violence, have been shown to increase HIV incidence among MSM
in the United States. However, this relationship has not been well
characterized in the general population, particularly in the context of poverty.
Prospective cohort study including a
nationally-representative sample of 34 427 men and women in the National
Epidemiologic Survey on Alcohol and Related Conditions wave 1 (2001-2002) and
wave 2 (2004-2005).
Weighted multivariable logistic regression models were used
to assess the association between syndemic factors and newly diagnosed HIV
infection, and to assess how living below the poverty line (based on 2001 US
Poverty Guidelines) modified this relationship.
The proportion of participants reporting new HIV diagnosis
in the past year was 0.22%, increasing from 0.19% among individuals with no
syndemic factor to 5.1% among those with four syndemic factors. Adjusting for
potentially confounding factors, each additional syndemic factor was associated
with a 47% increase in odds of HIV infection. The effect of syndemic factors was
stronger among individuals living below federal poverty guidelines compared to those living above poverty guidelines.
Among the US general population, the association between
co-occurring syndemic factors and incident HIV infection was stronger in the
setting of poverty. Mental health interventions, particularly in
socioeconomically disadvantaged areas, should be considered to reduce
transmission of HIV.
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By:
- 1aDepartment of Epidemiology, Harvard School of Public Health, Boston, Massachusetts bDepartment of Sociomedical Sciences, Columbia Mailman School of Public Health, New York cThe Fenway Institute, Fenway Health, Boston, Massachusetts, USA.
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