Watson Lakeshia, Haley Danielle, Turpin Rodman, Ma Tianzhou, Nguyen Quynh C, Mittal Mona, Dyer Typhanye
Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA.
Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA.
J Womens Health (Larchmt). 2024 Jun;33(6):816-826. doi: 10.1089/jwh.2023.0458. Epub 2024 Mar 19.
Syndemic models have been used in previous studies exploring HIV-related outcomes; however, these models do not fully consider intersecting psychosocial (, substance use, depressive symptoms) and structural factors (unstable housing, concentrated housing vacancy) that influence the lived experiences of women. Therefore, there is a need to explore the syndemic effects of psychosocial and structural factors on HIV risk behaviors to better explain the multilevel factors shaping HIV disparities among black women. This analysis uses baseline data (May 2009-August 2010) from non-Hispanic black women enrolled in the HIV Prevention Trials Network 064 Women's Seroincidence Study (HPTN 064) and the American Community Survey 5-year estimates from 2007 to 2011. Three parameterizations of syndemic factors were applied in this analysis a cumulative syndemic index, three syndemic groups reflecting the level of influence (psychosocial syndemic group, participant-level structural syndemic group, and a neighborhood-level structural syndemic group), and syndemic factor groups. Clustered mixed effects log-binomial analyses measured the relationship of each syndemic parameterization on HIV risk behaviors in 1,347 black women enrolled in HPTN 064. A higher syndemic score was significantly associated with increased prevalence of unknown HIV status of the last male sex partner (adjusted prevalence ratio (aPR) = 1.07, 95% confidence interval or CI 1.04-1.10), involvement in exchange sex (aPR = 1.17, 95% CI: 1.14-1.20), and multiple sex partners (aPR = 1.07, 95% CI: 1.06-1.09) in the last 6 months. A dose-response relationship was observed between the number of syndemic groups and HIV risk behaviors, therefore, being in multiple syndemic groups was significantly associated with increased prevalence of reporting HIV risk behaviors compared with being in one syndemic group. In addition, being in all three syndemic groups was associated with increased prevalence of unknown HIV status of the last male sex partner (aPR = 1.67, 95% CI: 1.43-1.95) and multiple sex partners (aPR = 1.53, 95% CI: 1.36-1.72). Findings highlight syndemic factors influence the lived experiences of black women.
共病模型已在先前探索与艾滋病病毒相关结果的研究中使用；然而，这些模型并未充分考虑影响女性生活经历的社会心理因素（如药物使用、抑郁症状）和结构因素（住房不稳定、集中的住房空置）的交叉影响。因此，有必要探讨社会心理和结构因素对艾滋病病毒风险行为的共病效应，以更好地解释影响黑人女性艾滋病病毒差异的多层次因素。本分析使用了来自参与艾滋病病毒预防试验网络064女性血清发病率研究（HPTN 064）的非西班牙裔黑人女性的基线数据（2009年5月至2010年8月）以及2007年至2011年美国社区调查的5年估计数据。本分析应用了共病因素的三种参数化方法：一个累积共病指数、反映影响水平的三个共病组（社会心理共病组、参与者层面的结构共病组和邻里层面的结构共病组）以及共病因素组。聚类混合效应对数二项式分析测量了1347名参与HPTN 064的黑人女性中每种共病参数化与艾滋病病毒风险行为之间的关系。较高的共病得分与过去6个月内最后一名男性性伴侣的艾滋病病毒感染状况未知的患病率增加显著相关（调整患病率比（aPR）=1.07，95%置信区间或CI 1.04 - 1.10）、参与性交易（aPR = 1.17，95% CI：1.14 - 1.20）以及多个性伴侣（aPR = 1.07，95% CI：1.06 - 1.09）显著相关。在共病组数量与艾滋病病毒风险行为之间观察到剂量反应关系，因此，与处于一个共病组相比，处于多个共病组与报告艾滋病病毒风险行为的患病率增加显著相关。此外，处于所有三个共病组与过去6个月内最后一名男性性伴侣的艾滋病病毒感染状况未知的患病率增加（aPR = 1.67，95% CI：1.43 - 1.95）以及多个性伴侣（aPR = 1.53，95% CI：1.36 - 1.72）相关。研究结果突出了共病因素对黑人女性生活经历的影响。
