A Transdiagnostic Minority Stress Treatment Approach for Gay and Bisexual Men's Syndemic Health Conditions

Developing and deploying separate treatments for separate conditions seems ill-suited to intervening upon the co-occurring, and possibly functionally similar, psychosocial conditions facing gay and bisexual men. This article argues for the need to create transdiagnostic interventions that reduce multiple syndemic conditions facing gay and bisexual men at the level of their shared source in minority stress pathways. 

This article first reviews psychosocial syndemic conditions affecting gay and bisexual men, then suggests pathways that might link minority stress to psychosocial syndemics based on recent advancements in emotion science, psychiatric nosology, and cognitive-affective neuroscience, and finally suggests cross-cutting psychosocial treatment principles to reduce minority stress-syndemic pathways among gay and bisexual men. Because minority stress serves as a common basis of all psychosocial syndemic conditions reviewed here, locating the pathways through which minority stress generates psychosocial syndemics and employing overarching treatment principles capable of simultaneously alleviating these pathways will ultimately create a transdiagnostic approach to improving gay and bisexual men's health. 

Clinical research and training approaches are suggested to further validate the pathways suggested here, establish the efficacy of treatment approaches tied to those pathways, and generate effective methods for disseminating a transdiagnostic minority stress treatment approach for gay and bisexual men's psychosocial syndemic health.

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By: Pachankis JE1.

1Social and Behavioral Sciences Division, Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, 60 College Street, Suite 316, New Haven, CT, 06510, USA

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Poverty Matters: Contextualizing the Syndemic Condition of Psychological Factors & Newly Diagnosed HIV Infection in the United States

'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: Oldenburg CE1, Perez-Brumer AG, Reisner SL.

• 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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The Predictive Syndemic Effect of Multiple Psychosocial Problems on Health Care Costs and Utilization among Sexual Minority Women

Previous studies documenting sexual minority women's disproportionate risk for a range of medical, mental health, and substance use disorders have not provided a predictive framework for understanding their interrelations and outcomes. 

The present study aimed to address this gap by testing the syndemic effect of co-occurring psychosocial problems on 7-year health care costs and utilization among sexual minority women. The sample was comprised of sexual minority women (N = 341) who were seen at an urban LGBT-affirmative community health center. Medical and mental health care utilization and cost data were extracted from electronic medical records. 

Demographically adjusted regression models revealed that co-occurring psychosocial problems (i.e., childhood sexual abuse, partner violence, substance use, and mental health distress [history of suicide attempt]) were all strongly interrelated. The presence of these indicators had a syndemic (additive) effect on medical costs and utilization and mental health utilization over 7-year follow-up, but no effect on 7-year mental health costs. 

These results suggest that the presence and additive effect of these syndemic conditions may, in part, explain increased medical costs and utilization (and higher medical morbidity) among sexual minority women.

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By: Valentine SE1,2, Elsesser S3, Grasso C3, Safren SA1,2,3, Bradford JB3, Mereish E4, O'Cleirigh C5,6,7.

• 1Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.
• 2Harvard Medical School, Boston, MA, USA.
• 3The Fenway Institute, Fenway Health, Boston, MA, USA.
• 4Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA.
• 5Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA. cocleirigh@mgh.harvard.edu.
• 6Harvard Medical School, Boston, MA, USA.
• 7The Fenway Institute, Fenway Health, Boston, MA, USA

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The Syndemic of HIV, HIV-Related Risk & Multiple Co-Morbidities among Women Who Use Drugs in Malaysia: Important Targets for Intervention

Substance use and HIV are syndemic public health problems in Malaysia. Harm reduction efforts to reduce HIV transmission have primarily focused on men with substance use disorders.

To explore HIV risk behaviors, substance use, and social factors associated with poor health outcomes among women who use drugs in Malaysia.

A cross-sectional survey of 103 drug-using women in Kuala Lumpur, Malaysia were recruited to assess their medical, psychiatric and social comorbidity as well as their engagement in nationally recommended HIV testing and monitoring activities.

One-third reported having ever injected drugs, with most (68.2%) having recently shared injection paraphernalia. Sex work (44.7%) and infrequent condom use (42.4%) were common as was underlying psychiatric illness and physical and sexual violence during childhood and adulthood. Most women (62.1%) had unstable living situations and suffered from an unmet need for social support and health services. HIV prevalence was high (20%) with only two thirds of women eligible for antiretroviral therapy having received it. Suboptimal HIV testing and/or monitoring was positively associated with interpersonal violence and negatively associated with drug injection.

Women who use drugs in Malaysia demonstrate considerable medical, psychiatric and social co-morbidity, which negatively contributes to optimal and crucial engagement in HIV treatment-as-prevention strategies. Mental health and social support may be key targets for future public health interventions aimed at drug-using women in Malaysia.

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By: Loeliger KB1, Marcus R2, Wickersham JA3, Pillai V4, Kamarulzaman A3, Altice FL5.

• 1Yale University School of Medicine, New Haven, CT, USA; Yale University School of Public Health, New Haven, CT, USA.
• 2Yale University School of Medicine, New Haven, CT, USA.
• 3Yale University School of Medicine, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
• 4Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
• 5Yale University School of Medicine, New Haven, CT, USA; Yale University School of Public Health, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia 

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