Department of Medicine, University of California San Diego, La Jolla, California, USA
Department of Medicine, University of California San Diego, La Jolla, California, USA.
Sex Transm Infect. 2023 Feb;99(1):7-13. doi: 10.1136/sextrans-2021-055224. Epub 2022 May 20.
Black women disproportionately experience STIs (including HIV/AIDS), gender-based violence, substance misuse and mental health conditions. Addressing a gap in syndemic research, we characterised comorbidity overlap within the context of sociostructural inequities and adverse childhood experiences (ACEs) among black women in Baltimore, Maryland. Between 2015 and 2018, black women (n=305) were recruited from STI clinics in Baltimore, Maryland. Among those with complete survey data (n=230), we conducted a latent class analysis to differentiate women based on their profile of the following syndemic comorbidities: STIs, adult sexual victimisation, substance misuse and mental health disorders. We then examined the association between ACEs and syndemic latent class membership. Thirty-three percent of women experienced three to nine ACEs before age 18 years, and 44% reported four to six comorbidities. The two-class latent class solution demonstrated the best fit model, and women were categorised in either class 1 (past-year STI; 59%) or class 2 (syndemic comorbidities; 41%). Women in class 2 were more likely to report unstable housing (10% vs 3%) and identify as bisexual/gay (22% vs 10%) than women in class 1. ACEs were significantly associated with an increased likelihood of class 2 membership. This study reinforces the importance of screening for ACEs and offering trauma-informed, integrated care for black women with syndemic comorbidities. It also highlights the critical nature of tailoring interventions to improve sociostructural equity, preventing and reducing syndemic development.
黑人女性不成比例地面临性传播感染（包括艾滋病毒/艾滋病）、性别暴力、药物滥用和精神健康问题。为了解决综合征研究中的一个差距，我们在马里兰州巴尔的摩的黑人女性中，从社会结构不平等和不良儿童经历（ACEs）的背景下描述了共病重叠。2015 年至 2018 年间，从马里兰州巴尔的摩的性传播感染诊所招募了黑人女性（n=305）。在那些完成调查数据的人中（n=230），我们进行了潜在类别分析，根据以下综合征共病的情况对女性进行区分：性传播感染、成年性虐待、药物滥用和精神健康障碍。然后，我们检查了 ACEs 与综合征潜在类别成员之间的关联。33%的女性在 18 岁之前经历了三到九个 ACEs，44%的女性报告了四到六个共病。两类别潜在类别解决方案表现出最佳拟合模型，女性被归类为类别 1（过去一年的性传播感染；59%）或类别 2（综合征共病；41%）。与类别 1 中的女性相比，类别 2 中的女性更有可能报告不稳定的住房（10%比 3%）和认同双性恋/同性恋（22%比 10%）。ACEs 与类别 2 成员的可能性增加显著相关。本研究强调了为有综合征共病的黑人女性筛查 ACEs 并提供创伤知情、综合护理的重要性。它还突出了根据需要调整干预措施以改善社会结构公平、预防和减少综合征发展的重要性。
