Journal of Urban Health

, Volume 90, Issue 5, pp 934-947

First online:

The Syndemic Effects of Intimate Partner Violence, HIV/AIDS, and Substance Abuse on Depression among Low-Income Urban Women

  • Samantha IllangasekareAffiliated withDepartment of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health Email author 
  • , Jessica BurkeAffiliated withDepartment of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health
  • , Geetanjali ChanderAffiliated withDivision of General Internal Medicine, Department of Medicine, Johns Hopkins Medical Institutions
  • , Andrea GielenAffiliated withDepartment of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health

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Intimate partner violence (IPV), HIV/AIDS, and substance use are epidemics among low-income urban women that have been described together as the “SAVA syndemic” because of their co-occurring nature. This study examines the synergistic or “syndemic” effect of these three health issues on depression among urban women and evaluates social support as a protective factor that might reduce depressive symptoms associated with the Substance Abuse, Violence, and AIDS (SAVA) syndemic. Data from 445 urban women were collected through in-person interviews. All women were over the age of 18, not pregnant, English speaking, and reported having a main partner in the past year. Twenty-five percent had experienced all three factors of the SAVA syndemic (were HIV-positive, had experienced IPV in the past year, and had used cocaine or heroin in their lifetime). HIV-positive status, hard drug use, IPV, and low levels of social support were all individually associated with greater depressive symptoms. When controlling for demographics and other SAVA factors, IPV and hard drug use in the past 30 days remained associated with depressive symptoms, as did low social support. However, social support did not modify the effect of the SAVA factors on depression. Compared to women who experienced no SAVA factors, women who had experienced all three factors were 6.77 times more likely to have depressive symptoms. These findings confirm that IPV is significantly associated with depressive symptoms and that the syndemic impact of IPV, substance use, and HIV could have even more extreme effects on depression outcomes.


Intimate partner violence HIV/AIDS Substance use Mental health Syndemics