Skip to main content

Advertisement

SpringerLink
Log in

Syndemic Vulnerability, Sexual and Injection Risk Behaviors, and HIV Continuum of Care Outcomes in HIV-Positive Injection Drug Users

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Limited investigations have been conducted on syndemics and HIV continuum of care outcomes. Using baseline data from a multi-site, randomized controlled study of HIV-positive injection drug users (n = 1,052), we examined whether psychosocial factors co-occurred, and whether these factors were additively associated with behavioral and HIV continuum of care outcomes. Experiencing one type of psychosocial problem was significantly (p < 0.05) associated with an increased odds of experiencing another type of problem. Persons with 3 or more psychosocial problems were significantly more likely to report sexual and injection risk behaviors and were less likely to be adherent to HIV medications. Persons with 4 or more problems were less likely to be virally suppressed. Reporting any problems was associated with not currently taking HIV medications. Our findings highlight the association of syndemics not only with risk behaviors, but also with outcomes related to the continuum of care for HIV-positive persons.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. The White House Office of National AIDS Policy. National HIV/AIDS strategy for the United States. July 2010. Washington DC: The White House. http://www.whitehouse.gov/administration/eop/onap/nhas. Accessed 23 Sept 2013.

  2. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. New Engl J Med. 2011;365:493–505.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. The White House. Executive Order: HIV care continuum initiative. July 2013. Washington DC: The White House. http://www.whitehouse.gov/the-press-office/2013/07/15/executive-order-hiv-care-continuum-initiative. Accessed 23 Sept 2013.

  4. Hall HI, Frazier EL, Rhodes P, et al. Differences in human immunodeficiency virus care and treatment among subgroups in the United States. JAMA Intern Med. 2013;. doi:10.1001/jamainternmed.2013.6841.

    Google Scholar 

  5. Cohen SM, Van Handel MM, Branson BM, et al. Vital Signs: HIV prevention through care and treatment: United States. MMWR. 2011;2011(60):1618–23.

    Google Scholar 

  6. Centers for Disease Control and Prevention. HIV Surveillance: Epidemiology of HIV Infection (through 2011). 2013. http://www.cdc.gov/hiv/library/slideSets/index.html. Accessed 22 July 2014.

  7. Avants SK, Warburton LA, Hawkins KA, Margolin A. Continuation of high-risk behavior by HIV-positive drug users: treatment implications. J Subst Abuse Treat. 2000;19:15–22.

    Article  CAS  PubMed  Google Scholar 

  8. Kwiatkowski CF, Booth R. HIV-seropositive drug users and unprotected sex. AIDS Behav. 1998;2:151–60.

    Article  Google Scholar 

  9. Knight KR, Shade SB, Purcell DW, et al. Sexual transmission risk behavior reported among behaviorally bisexual HIV-seropositive injection drug using men. J AIDS. 2007;46(Supplement 2):S80–7.

    Google Scholar 

  10. Latka MH, Metsch LR, Mizuno Y, et al. Unprotected sex among HIV-positive injection drug using women and their serodiscordant male partners: role of personal and partner influences. J AIDS. 2006;42:222–8.

    Google Scholar 

  11. Latkin CA, Buchanan AS, Metsch LR, et al. Predictors of sharing injection equipment by HIV-seropositive injection drug users. J AIDS. 2008;49:447–50.

    Google Scholar 

  12. Metsch LR, McCoy CB, Lai S, Miles C. Continuing risk behaviors among HIV-seropositive chronic drug users in Miami, Florida. AIDS Behav. 1998;2:161–9.

    Article  Google Scholar 

  13. Meader N, Semaan S, Halton M, et al. An international systematic review and meta-analysis of multisession psychosocial interventions compared with educational or minimal interventions on the HIV sex risk behaviors of people who use drugs. AIDS Behav. 2013;17:1963–78.

    Article  PubMed  Google Scholar 

  14. Purcell DW, Mizuno Y, Metsch LR, et al. Unprotected sexual behavior among heterosexual HIV-positive injection drug using men: associations by partner type and partner serostatus. J Urban Health. 2006;83:656–68.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Krusi A, Evan W, Julio M, Thomas K. Social and structural determinants of HAART access and adherence among injection drug users. Int J Drug Policy. 2010;21:4–9.

    Article  PubMed  Google Scholar 

  16. Mizuno Y, Purcell DW, Borkowski TM, Knight K. The life priorities of HIV-seropositive injection drug users: findings from a community-based sample. AIDS Behav. 2003;7:395–403.

    Article  PubMed  Google Scholar 

  17. Singer M. AIDS and the health crisis of the US urban poor; The perspective of critical medical anthropology. Soc Sci Med. 1994;39:931–48.

    Article  CAS  PubMed  Google Scholar 

  18. Mustanski B, Garofalo R, Herrick A, Donenberg G. Psychological health problems increase risk for HIV among urban young men who have sex with men: preliminary evidence of a syndemic in need of attention. Ann Behav Med. 2007;34:37–45.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Singer MC, Erickson PI, Badiane L, et al. Syndemics, sex, and the city: understanding sexually transmitted diseases in social and cultural context. Soc Sci Med. 2006;63:2010–21.

    Article  PubMed  Google Scholar 

  20. Dyer TP, Shoptaw S, Guadamuz TE, et al. Application of syndemic theory to black men who have sex with men in the Multicenter AIDS cohort study. J Urban Health. 2012;89:697–708.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Halkitis PN, Moeller RW, Siconolfi DE, Storholm ED, Solomon TM, Bub KL. Measurement model exploring a syndemic in emerging adult gay and bisexual men. AIDS Behav. 2013;17:662–73.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Jie W, Ciyong L, Xueqing D, Hui W, Lingyao H. A syndemic of psychosocial problems places the MSM population at greater risk of HIV infection. PLoS One. 2012;7:e32312.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Parsons JT, Grov C, Golub SA. Sexual compulsivity, co-occuring psychosocial health problems, and HIV risk among gay and bisexual men: further evidence of a syndemic. AJPH. 2012;102:156–62.

    Article  Google Scholar 

  24. Stall R, Mills T, Williamson J, Hart T, et al. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. AJPH. 2003;93:939–42.

    Article  Google Scholar 

  25. Brennan J, Kuhns LM, Johnson AK, Belzer M, Wilson EC, Garofalo R, the Adolescent Medicine Trials Network for HIV/AIDS Interventions. Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalization. AJPH. 2012;102:1751–7.

    Article  Google Scholar 

  26. Senn TE, Carey MP, Vanable PA. The intersection of violence, substance use, depression, and STDs: testing of a syndemic pattern among patients attending an urban STD clinic. J Natl Med Assoc. 2010;102:614–20.

    PubMed Central  PubMed  Google Scholar 

  27. Pitpitan EV, Kalichman SC, Eaton LA, et al. Co-occurring psychosocial problems and HIV risk among women attending drinking venues in a South African township: a syndemic approach. Ann Behav Med. 2013;45:153–62.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Gonsalez-Guarcia RM, McCabe BE, Florom-Smith A, Cianelli R, Peragallo N. Substance abuse, violence, HIV, and depression: an underlying syndemic factor among Latinas. Nurs Res. 2011;60:182–9.

    Article  Google Scholar 

  29. Kurtz SP, Buttram ME, Surratt HL, Stall RD. Resilience, syndemic factors, and serosorting behaviors among HIV-positive and HIV-negative substance-using MSM. AIDS Educ Prev. 2012;24:193–205.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Operario D, Nemoto T. HIV in transgender communities: syndemic dynamics and a need for multicomponent interventions. J AIDS. 2013;55(Supplement 2):S91–3.

    Google Scholar 

  31. Knight KR, Purcell D, Dawson-Rose C, Gómez CA, Halkitis PN, The SUDIS Team. Sexual risk taking among HIV-positive injection drug users: contexts, characteristics, and implications for prevention. AIDS Educ Prev. 2005;17(1 Supplement A):76–88.

    Article  PubMed  Google Scholar 

  32. Anema A, Wood E, Weiser SD, Qi J, Montaner JS, Kerr T. Hunger and associated harms among injection drug users in an urban Canadian setting. Subst Abuse Treat Prev Policy. 2010;5:20.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Mateu-Gelabert P, Maslow C, Flom PL, Sandoval M, Bolyard M, Friedman SR. Keeping it together: stigma, response, and perception of risk in relationships between drug injectors and crack smokers, and other community residents. AIDS Care. 2005;17:802–13.

    Article  CAS  PubMed  Google Scholar 

  34. Mitchell SG, Edwards LV, Mackenzie S, et al. Participants’ description of social support within a multisite intervention for HIV-seropositive injection drug users (INSPIRE). J AIDS. 2007;46(Supplement 2):S55–63.

    Google Scholar 

  35. Friedman SR, Sandoval M, Mateu-Gelabert P, Meylakhs P, Des Jarlais DC. Symbiotic goals and the prevention of blood-borne viruses among injection drug users. Subst Use Misuse. 2011;46:307–515.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Centers for Disease Control and Prevention. Integrated prevention services for HIV infection, viral hepatitis, sexually transmitted diseases, and tuberculosis for persons who use drugs illicitly: Summary guidance from CDC and US Department of Health and Human Services. MMWR. 2012;61(rr05):1–40.

    Google Scholar 

  37. Milloy M-J, Kerr T, Buxton J, et al. Social and environmental predictors of plasma HIV RNA rebound among injection drug users treated with antiretroviral therapy. J AIDS. 2012;59:393–9.

    Google Scholar 

  38. Milloy M-J, Wood E, Small W, et al. Incarceration experiences in a cohort of active injection drug users. Drug Alcohol Rev. 2008;27:693–9.

    Article  PubMed  Google Scholar 

  39. Kittikraisak W, Davidson PJ, Hahn JA, et al. Incarceration among young injectors in San Francisco associations with risk for hepatitis virus infection. J Subst Use. 2006;11:271–81.

    Article  Google Scholar 

  40. Small W, Wood E, Betteridge G, Montaner J, Kerr T. The impact of incarceration upon adherence to HIV treatment among HIV-positive injection drug users: a qualitative study. AIDS Care. 2009;21:708–14.

    Article  PubMed  Google Scholar 

  41. Martikainen P, Bartley M, Lahelma E. Psychosocial determinants of health in social epidemiology. Int J Epidemiol. 2002;31:1091–3.

    Article  PubMed  Google Scholar 

  42. Purcell DW, Latka MH, Metsch LR, et al. Results from a randomized controlled trial of a peer-mentoring intervention to reduce HIV transmission and increase access to care and adherence to HIV medications among HIV-seropositive injection drug users. J AIDS. 2007;46(Supplement 2):S35–47.

    Google Scholar 

  43. Purcell DW, Metsch LR, Latka M, et al. Interventions for seropositive injectors-research and evaluation: an integrated behavioral intervention with HIV-positive injection drug users to address medical care, adherence, and risk reduction. J AIDS. 2004;1(37):S110–8.

    Google Scholar 

  44. Derogatis LR, Spencer PM. The Brief Symptom Inventory (BSI): administration, scoring, and procedure manual. Baltimore, MD: Wiley; 1982.

    Google Scholar 

  45. Barrera MA. A method for assessing social support networks in community survey research. Connections. 1980;1980(3):3–8.

    Google Scholar 

  46. Arnsten JH, Li X, Mizuno Y, et al. Factors associated with antiretroviral therapy adherence and medication errors among HIV-infected injection drug users. J AIDS. 2007;46(Supplement 2):S64–71.

    Google Scholar 

  47. Rhodes T, Singer M, Bourgois P, Friedman SR, Strathdee SA. The social structural production of HIV risk among injection drug users. Soc Sci Med. 2005;61:1026–44.

    Article  PubMed  Google Scholar 

  48. Ferlatte O, Hottes TS, Trussler T, Marchand R. Evidence of a syndemic among young Canadian gay and bisexual men: Uncovering the associations between anti-gay experiences, psychosocial issues, and HIV risk. AIDS Behav. 2014;18:1256–63.

    Article  PubMed  Google Scholar 

  49. Mizuno Y, Borkowf C, Millett GA, Bingham T, Ayala G, Stuve A. Homophobia and racism experienced by Latino men who have sex with men: Correlates of exposure and associations with HIV risk behaviors. AIDS Behav. 2012;16:724–35.

    Article  PubMed  Google Scholar 

  50. Mizuno Y, Borkowf CB, Ayala G, Carballo-Dieguez A, Millett GA. Correlates of sexual risk for HIV among US-born and foreign-born Latino men who have sex with men (MSM): an analysis from the Brothers y Hermanos Study. J Immigr Minor Health. 2013;. doi:10.1007/s10903-013-9894-5.

    Google Scholar 

  51. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Bethesda, MD: Department of Health and Human Services (DHHS); 2013 Feb 12. Various p. [937 references].

  52. Valdiserri RO, Forsyth AD, Yakovchenko V, Koh HK. Measuring what matters: Development of standard HIV core indicators across the U.S. Department of Health and Human Services. Public Health Rep. 2013;128:354–9.

    PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

The INSPIRE Team includes the following people: Carl Latkin, Amy Knowlton, and Karin Tobin (Baltimore); Lisa Metsch, Eduardo Valverde, James Wilkinson, and Martina DeVarona (Miami); Mary Latka, Dave Vlahov, Phillip Coffin, Marc Gourevitch, Julia Arnsten, and Robert Gern (New York); Cynthia Gomez, Kelly Knight, Carol Dawson Rose, Starley Shade, and Sonja Mackenzie (San Francisco); David Purcell, Yuko Mizuno, Scott Santibanez, Richard Garfein, and Ann O’Leary (Centers for Disease Control and Prevention [CDC]); Lois Eldred, Kathleen Handley (Health Resources and Services Administration). We would also like to acknowledge the following people for their contributions to this research: Susan Sherman, Roeina Marvin, Joanne Jenkins, Donny Gann, and Tonya Johnson (Baltimore); Clyde McCoy, Rob Malow, Wei Zhao, Lauren Gooden, Sam Comerford, Virginia Locascio, Curtis Delford, Laurel Hall, Henry Boza, Cheryl Riles, Faye Yeomans (Miami); George Fesser, Carol Gerran, Diane Thornton (New York); Caryn Pelegrino, Barbara Garcia, Jeff Moore, Erin Rowley, Debra Allen, Dinah Iglesia-Usog, Gilda Mendez, Paula Lum, and Greg Austin (San Francisco); Gladys Ibanez, Hae-Young Kim, Toni McWhorter, Jan Moore, Lynn Paxton, and John Williamson (CDC); Lee Lam, Jeanne Urban, Stephen Soroka, Zilma Rey, Astrid Ortiz, Sheila Bashirian, Marjorie Hubbard, Karen Tao, Bharat Parekh, Thomas Spira (CDC Laboratory). This study was supported by the Centers for Disease Control and Prevention and the Health Resources and Services Administration.

Author information

Authors and Affiliations

  1. Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE Mail Stop E37, Atlanta, GA, 30333, USA

    Yuko Mizuno & David W. Purcell

  2. Johns Hopkins Bloomberg School of Public Health Department of Health, Behavior and Society, Baltimore, MD, 21205, USA

    Amy R. Knowlton

  3. Division of Pediatric Clinical Research Leonard M. Miller School of Medicine Batchelor Children’s Research Institute, Miami, FL, 33101, USA

    James D. Wilkinson

  4. Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA

    Marc N. Gourevitch

  5. Department of Anthropology, History, and Social Medicine, University of California- San Francisco, San Francisco, CA, 94143, USA

    Kelly R. Knight

Authors
  1. Yuko Mizuno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David W. Purcell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amy R. Knowlton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James D. Wilkinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marc N. Gourevitch
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kelly R. Knight
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yuko Mizuno.

Additional information

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mizuno, Y., Purcell, D.W., Knowlton, A.R. et al. Syndemic Vulnerability, Sexual and Injection Risk Behaviors, and HIV Continuum of Care Outcomes in HIV-Positive Injection Drug Users. AIDS Behav 19, 684–693 (2015). https://doi.org/10.1007/s10461-014-0890-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-014-0890-0

Keywords

Search

Navigation