McDaid Lisa M, Flowers Paul, Ferlatte Olivier, McAloney-Kocaman Kareena, Gilbert Mark, Frankis Jamie
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK.
Department of Social and Preventative Medicine, School of Public Health, University of Montreal, 7101 Avenue du Parc (3rd Floor), Montreal, Quebec, H3N 1X9, Canada.
SSM Popul Health. 2019 Nov 27;10:100519. doi: 10.1016/j.ssmph.2019.100519. eCollection 2020 Apr.
Globally, gay, bisexual and other men who have sex with men (GBMSM) experience an increased burden of poor sexual, mental and physical health. Syndemics theory provides a framework to understand comorbidities and health among marginalised populations. Syndemics theory attempts to account for the social, environmental, and other structural contexts that are driving and/or sustaining simultaneous multiple negative health outcomes, but has been widely critiqued. In this paper, we conceptualise a new framework to counter syndemics by assessing the key theoretical mechanisms by which pathogenic social context variables relate to ill-health. Subsequently, we examine how salutogenic, assets-based approaches to health improvement could function among GBMSM across diverse national contexts. Comparative quantitative secondary analysis of data on syndemics and community assets are presented from two international, online, cross-sectional surveys of GBMSM (SMMASH2 in Scotland, Wales, Northern Ireland and the Republic of Ireland and Sex Now in Canada). Negative sexual, mental and physical health outcomes were clustered as hypothesised, providing evidence of the syndemic. We found that syndemic ill-health was associated with social isolation and the experience of stigma and discrimination, but this varied across national contexts. Moreover, while some of our measures of community assets appeared to have a protective effect on syndemic ill-health, others did not. These results present an important step forward in our understanding of syndemic ill-health and provide new insights into how to intervene to reduce it. They point to a theoretical mechanism through which salutogenic approaches to health improvement could function and provide new strategies for working with communities to understand the proposed processes of change that are required. To move forward, we suggest conceptualising syndemics within a complex adaptive systems model, which enables consideration of the development, sustainment and resilience to syndemics both within individuals and at the population-level.
在全球范围内，男同性恋者、双性恋者以及其他与男性发生性行为的男性（GBMSM）面临着性健康、心理健康和身体健康不佳的负担增加的问题。综合征理论提供了一个框架，用于理解边缘化人群中的共病和健康状况。综合征理论试图解释推动和/或维持同时出现的多种负面健康结果的社会、环境和其他结构背景，但该理论受到了广泛批评。在本文中，我们通过评估致病性社会背景变量与健康不良相关的关键理论机制，构思了一个应对综合征的新框架。随后，我们研究了基于健康资产的促健康方法如何在不同国家背景下的GBMSM中发挥作用。我们对两项针对GBMSM的国际在线横断面调查（苏格兰、威尔士、北爱尔兰和爱尔兰共和国的SMMASH2以及加拿大的“当下的性”）的数据进行了比较性定量二次分析，呈现了关于综合征和社区资产的数据。负面的性健康、心理健康和身体健康结果如假设的那样聚集在一起，为综合征提供了证据。我们发现，综合征性健康不良与社会隔离以及耻辱感和歧视经历有关，但这种情况在不同国家背景下有所不同。此外，虽然我们的一些社区资产衡量指标似乎对综合征性健康不良有保护作用，但其他指标则没有。这些结果是我们在理解综合征性健康不良方面向前迈出的重要一步，并为如何进行干预以减少这种不良状况提供了新的见解。它们指出了一种理论机制，通过这种机制基于健康资产的促健康方法可以发挥作用，并为与社区合作理解所需的拟议变化过程提供了新策略。为了取得进展，我们建议在复杂适应系统模型中对综合征进行概念化，这使得能够在个体层面和人群层面考虑综合征的发展、维持和恢复力。
