Center for Behavioural and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles, USA.
Behaviours and Health Risks and Disease Elimination Programs, Burnet Institute, Melbourne, Australia.
Drug Alcohol Rev. 2020 Feb;39(2):116-127. doi: 10.1111/dar.13026.
Past research investigating syndemic factors and HIV-related outcomes has overlooked the impact of structural conditions on behaviours linked with HIV transmission and disease progression. Given prevalent substance use among our sample, we explored whether four structural conditions indicative of social marginalisation and previously correlated with increased risk for HIV infection demonstrated syndemic (additive/synergistic) effects on: (i) HIV viral suppression; and (ii) self-reported involvement in sexual HIV transmission behaviours among a prospective cohort mostly comprising men of colour who have sex with men (MCSM; i.e. Latino/Hispanic and African American/black men) in Los Angeles County.
Data were collected between August 2014 and March 2017. The structural conditions of interest were: current unemployment, recent (≤6 months) incarceration history, 'unstable' accommodation (past month) and remote (>6 months) contact with health-care providers. Generalised estimating equations assessed possible additive effects of experiencing multiple structural conditions, and possible synergistic effects on the HIV-related outcomes.
Of 428 participants, nearly half (49%) were HIV-positive at baseline. Involvement in sexual HIV transmission risk behaviours varied over follow-up (22-30%). Reporting ≥2 structural syndemic conditions was significantly associated with reporting sexual HIV transmission risk behaviours among HIV-negative participants, and detectable viral load among HIV-positive participants. Frequent methamphetamine use was consistently associated with the HIV-related outcomes across the final multivariate models.
When developing initiatives to address HIV transmission among marginalised sub-populations including MCSM, we must holistically consider systemic and structural issues (e.g. unemployment and homelessness), especially in the context of prevalent substance use.
过去研究调查了综合征因素和与 HIV 相关的结果，但忽略了结构条件对与 HIV 传播和疾病进展相关行为的影响。鉴于我们的样本中普遍存在物质使用，我们探讨了四个结构条件（表明社会边缘化，并且以前与 HIV 感染风险增加相关）是否对以下方面具有综合征（累加/协同）效应：（i）HIV 病毒抑制；（ii）在洛杉矶县主要由男男性行为者（即拉丁裔/西班牙裔和非裔美国人/黑人性行为者）组成的前瞻性队列中，自我报告参与与性传播的 HIV 传播行为。
数据收集于 2014 年 8 月至 2017 年 3 月之间。感兴趣的结构条件包括：当前失业、最近（≤6 个月）监禁史、“不稳定”住所（过去一个月）和与医疗保健提供者的远程（>6 个月）联系。广义估计方程评估了经历多种结构条件的可能累加效应，以及对 HIV 相关结果的可能协同效应。
在 428 名参与者中，近一半（49%）在基线时 HIV 呈阳性。在随访期间，性传播 HIV 风险行为有所不同（22-30%）。报告≥2 种结构综合征条件与 HIV 阴性参与者报告性传播 HIV 风险行为以及 HIV 阳性参与者可检测到的病毒载量显著相关。经常使用甲基苯丙胺与最终多变量模型中的 HIV 相关结果始终相关。
在制定针对边缘化亚人群（包括男男性行为者）的 HIV 传播干预措施时，我们必须全面考虑系统性和结构性问题（例如失业和无家可归），特别是在普遍存在物质使用的情况下。
