Psychosocial health problems increase risk for HIV among urban young men who have sex with men: Preliminary evidence of a syndemic in need of attention

  • Brian Mustanski
  • Robert Garofalo
  • Amy Herrick
  • Geri Donenberg
Article

Abstract

Background: Young men who have sex with men (YMSM) experience disparities in HIV rates and potentially in mental health, substance abuse, and exposure to violence.Purpose: We assessed the extent to which these psychosocial health problems had an additive effect on increasing HIV risk among YMSM.Methods: An urban sample of 310 ethnically diverse YMSM reported on psychosocial health problems, sexual risk behaviors, and HIV status. A count of psychosocial health problems was calculated to test the additive relationship to HIV risk.Results: The prevalence of psychosocial health problems varied from 23% for regular binge drinking to 34% for experiencing partner violence. Rates of sexual risk behaviors were high and 14% of YMSM reported receiving a HIV + test result. Psychosocial health problems cooccurred, as evidenced by significant bivariate odds ratios (ORs) between 12 of the 15 associations tested. Number of psychosocial health problems significantly increased the odds of having multiple anal sex partners (OR=1.24), unprotected anal sex (OR=1.42), and an HIV-positive status (OR 1.42), after controlling for demographic factors.Conclusions: These data suggest the existence of cooccurring epidemics, or “syndemic,-of health problems among YMSM. Disparities exist not only in the prevalence of HIV among YMSM but also in research to combat the epidemic within this vulnerable population. Future research is needed to identify risk and resiliency factors across the range of health disparities and develop interventions that address this syndemic.

References

  1. (1).
    Centers for Disease Control and Prevention:HIV/AIDS Among Youth. Atlanta, GA: US Department of Health and Human Services, 2005.Google Scholar
  2. (2).
    Wolitski RJ, Valdiserri RO, Denning PH, Levine WC: Are we headed for a resurgence of the HIV epidemic among men who have sex with men?American Journal of Public Health. 2001,91:883-88.CrossRefPubMedGoogle Scholar
  3. (3).
    Centers for Disease Control and Prevention: HIV incidence among young men who have sex with men—seven U.S. cities, 1994-000.Morbidity & Mortality Weekly Report. 2001,50:440-44.Google Scholar
  4. (4).
    Valleroy LA, MacKellar DA, Karon JM, et al.: HIV prevalence and associated risks in young men who have sex with men. Young men’s survey study group.Journal of the American Medical Association. 2000,284:198-04.CrossRefPubMedGoogle Scholar
  5. (5).
    Valleroy LA, MacKellar DA, Karon JM, Janssen RS, Hayman CR: HIV infection in disadvantaged out-of-school youth: Prevalence for U.S. Job Corps entrants, 1990 through 1996.Journal of Acquired Immune Deficiency Syndrome & Human Retrovirology. 1998,19:67-3.Google Scholar
  6. (6).
    Santelli J, Ott MA, Lyon M, et al.: Abstinence and abstinence-only education: A review of U.S. policies and programs.Journal of Adolescent Health. 2006,38:72-1.CrossRefPubMedGoogle Scholar
  7. (7).
    Goodenow C, Netherland J, Szalacha L: AIDS-related risk among adolescent males who have sex with males, females, or both: Evidence from a statewide survey.American Journal of Public Health. 2002,92:203-10.CrossRefPubMedGoogle Scholar
  8. (8).
    Seal DW, Kelly JA, Bloom FR, et al.: HIV prevention with young men who have sex with men: What young men themselves say is needed.Aids Care. 2000,12:5-6.CrossRefPubMedGoogle Scholar
  9. (9).
    Robin L, Dittus P, Whitaker D, et al.: Behavioral interventions to reduce incidence of HIV, STD, and pregnancy among adolescents: A decade in review.Journal of Adolescent Health. 2004,34:3-6.CrossRefPubMedGoogle Scholar
  10. (10).
    Mullen PD, Ramirez G, Strouse D, Hedges LV, Sogolow E: Meta-analysis of the effects of behavioral HIV prevention interventions on the sexual risk behavior of sexually experienced adolescents in controlled studies in the United States.Journal of Acquired Immune Deficiency Syndrome. 2002,30:S94-S105.Google Scholar
  11. (11).
    Johnson BT, Carey MP, Marsh KL, Levin KD, Scott-Sheldon LA: Interventions to reduce sexual risk for the human immunodeficiency virus in adolescents, 1985-000: A research synthesis.Archives of Pediatric & Adolescent Medicine. 2003,157:381-88.CrossRefGoogle Scholar
  12. (12).
    Pedlow CT, Carey MP: Developmentally appropriate sexual risk reduction interventions for adolescents: Rationale, review of interventions, and recommendations for research and practice.Annals of Behavioral Medicine. 2004,27:172-84.CrossRefPubMedGoogle Scholar
  13. (13).
    Herbst JH, Sherba RT, Crepaz N, et al.: A meta-analytic review of HIV behavioral interventions for reducing sexual risk behavior of men who have sex with men.Journal of Acquired Immune Deficiency Syndrome. 2005,39:228-41.Google Scholar
  14. (14).
    Lyles CM, Kay LS, Crepaz N, et al.: Best-evidence interventions: Findings from a systematic review of HIV behavioral interventions for US populations at high risk, 2000-004.American Journal of Public Health. 2007,97:133-43.CrossRefPubMedGoogle Scholar
  15. (15).
    Kegeles SM, Hays RB, Coates TJ: The Mpowerment Project: A community-level HIV prevention intervention for young gay men.American Journal of Public Health. 1996,86:1129-136.CrossRefPubMedGoogle Scholar
  16. (16).
    Thiede H, Valleroy LA, MacKellar DA, et al.: Regional patterns and correlates of substance use among young men who have sex with men in 7 US urban areas.American Journal of Public Health. 2003,93:1915-921.CrossRefPubMedGoogle Scholar
  17. (17).
    Safren SA, Heimberg RG: Depression, hopelessness, suicidality, and related factors in sexual minority and heterosexual adolescents.Journal of Consulting & Clinical Psychology. 1999,67:859-66.CrossRefGoogle Scholar
  18. (18).
    Savin-Williams RC: Verbal and physical abuse as stressors in the lives of lesbian, gay male, and bisexual youths: Associations with school problems, running away, substance abuse, prostitution, and suicide.Journal of Consulting & Clinical Psychology. 1994,62:261-69.CrossRefGoogle Scholar
  19. (19).
    Koblin BA, Torian L, Xu G, et al.: Violence and HIV-related risk among young men who have sex with men.AIDS Care. 2006,18:961-67.CrossRefPubMedGoogle Scholar
  20. (20).
    Garofalo R, Wolf RC, Wissow LS, Woods ER, Goodman E: Sexual orientation and risk of suicide attempts among a representative sample of youth.Archives of Pediatric & Adolescent Medicine. 1999,153:487-93.Google Scholar
  21. (21).
    Neale MC, Kendler KS: Models of comorbidity for multifactorial disorders.American Journal of Human Genetics. 1995,57:935-53.PubMedGoogle Scholar
  22. (22).
    Singer M: AIDS and the health crisis of the U.S. urban poor; The perspective of critical medical anthropology.Social Science & Medicine. 1994,39:931-48.CrossRefGoogle Scholar
  23. (23).
    CDC Syndemics Prevention Network:Exploring the Foundations of a Syndemic Orientation in Public Health. Retrieved October 10, 2006 from http://www.cdc.gov/syndemics/pdfs/foundations.pdfGoogle Scholar
  24. (24).
    Singer MC, Erickson PI, Badiane L, et al.: Syndemics, sex and the city: Understanding sexually transmitted diseases in social and cultural context.Social Science & Medicine. 2006,63:2010-021.CrossRefGoogle Scholar
  25. (25).
    Stall R, Mills TC, Williamson J, et al.: Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men.American Journal of Public Health. 2003,93:939-42.CrossRefPubMedGoogle Scholar
  26. (26).
    Gay and Lesbian Medical Association:Healthy People 2010 Companion Document for Lesbian Gay, Bisexual, and Transgender (LGBT) Health. San Francisco, CA: GLMA, 2001.Google Scholar
  27. (27).
    Dean L, Meyer IH, Robinson K, et al.: Lesbian, gay, bisexual, and transgender health: Findings and concerns.Journal of the Gay and Lesbian Medical Association. 2000,4:102-51.CrossRefGoogle Scholar
  28. (28).
    Donenberg GR, Emerson E, Bryant FB, Wilson H, Weber-Shifrin E: Understanding AIDS-risk behavior among adolescents in psychiatric care: Links to psychopathology and peer relationships.Journal of the American Academy of Child & Adolescent Psychiatry. 2001,40:642-53.CrossRefGoogle Scholar
  29. (29).
    Derogatis LR: BSI-18:Administration, Scoring and Procedures Manual. Minneapolis, MN: National Computer Systems, 2000.Google Scholar
  30. (30).
    Zabora J, BrintzenhofeSzoc K, Jacobsen P, et al.: A new psychosocial screening instrument for use with cancer patients.Psychosomatics. 2001,42:241-46.CrossRefPubMedGoogle Scholar
  31. (31).
    Boulet J, Boss MW: Reliability and validity of the brief symptom inventory.Psychological Assessment. 1991,3:433-37.CrossRefGoogle Scholar
  32. (32).
    Little RJA, Rubin DB:Statistical Analysis with Missing Data. New York: Wiley, 1987.Google Scholar
  33. (33).
    United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration:National Survey on Drug Use and Health, 2004. Retrieved October 13, 2006 from http://www.icpsr.umich.edu/SAMHDAGoogle Scholar
  34. (34).
    Centers for Disease Control and Prevention: Youth risk behavior surveillance—United States, 2005.Morbidity and Mortality Weekly Report. 2006,55:1-12.Google Scholar
  35. (35).
    Purswani MU, Hagmann S, Bakshi SS, et al.: A blinded survey of the seroprevalence of HIV-1 infection in an inner-city adolescent and young adult population attending a community hospital in the United States.Journal of Adolescent Health. 2007,40:182-84.CrossRefPubMedGoogle Scholar
  36. (36).
    Morris M, Handcock MS, Miller WC, et al.: Prevalence of HIV infection among young adults in the United States: Results from the add health study.American Journal of Public Health. 2006,96:1091-097.CrossRefPubMedGoogle Scholar
  37. (37).
    Heckathorn DD: Respondent-driven sampling: A new approach to the study of hidden populations.Social Problems. 1997,44:174-00.CrossRefGoogle Scholar
  38. (38).
    Anderson AL: Strengths of gay male youth: An untold story.Child and Adolescent Social Work Journal. 1998,15:55-1.CrossRefGoogle Scholar
  39. (39).
    Savin-Williams RC:Gay and Lesbian Youth: Expressions of Identity. New York: Hemisphere, 1990.Google Scholar
  40. (40).
    Fergus S, Zimmerman MA: Adolescent resilience: A framework for understanding healthy development in the face of risk.Annual Review of Public Health. 2005,26:399-19.CrossRefPubMedGoogle Scholar
  41. (41).
    Elliott DS, Huizinga D, Menard S:Multiple Problem Youth: Delinquency, Substance Use, and Mental Health Problems. New York: Springer Verlag, 1989.Google Scholar
  42. (42).
    Osgood DW, Johnston LD, O’Malley PM, Bachman JG: The generality of deviance in late adolescence and early adulthood.American Sociological Review. 1988,53:81-3.CrossRefGoogle Scholar
  43. (43).
    Fergusson DM, Horwood LJ, Lynskey MT: The comorbidities of adolescent problem behaviors -a latent class model.Journal of Abnormal Child Psychology. 1994,22:339-54.CrossRefPubMedGoogle Scholar
  44. (44).
    Huizinga D, Lobber R, Thornberry TP: Longitudinal study of delinquency, drug abuse, sexual activity, and pregnancy among children and youth in three cities.Public Health Reports. 1993,108:90-6.PubMedGoogle Scholar
  45. (45).
    Loeber R, Farrington DP, Stouthamer-Loeber M, Van Kammen WB: Multiple risk factors for multiproblem boys: Co-occurrence of delinquency, substance use, attention deficit, conduct problems, physical aggression, covert behavior, depressed mood, and shy/withdrawn behavior. In Jessor R (ed),New Perspectives on Adolescent Risk Behavior. Cambridge, UK: Cambridge University Press, 1998, xii, 564.Google Scholar
  46. (46).
    Krueger RF, Hicks BM, Patrick CJ, et al.: Etiologic connections among substance dependence, antisocial behavior, and personality: Modeling the externalizing spectrum.Journal of Abnormal Psychology. 2002,111:411-24.CrossRefPubMedGoogle Scholar
  47. (47).
    Fortenberry JD, Costa FM, Jessor R, Donovan JE: Contraceptive behavior and adolescent lifestyles: A structural modeling approach.Journal of Research on Adolescents. 1997,7:307-29.CrossRefGoogle Scholar
  48. (48).
    Duncan SC, Duncan TE, Biglan A, Ary D: Contributions of the social context to the development of adolescent substance use: A multivariate latent growth modeling approach.Drug and Alcohol Dependence. 1998,50:57-1.CrossRefPubMedGoogle Scholar
  49. (49).
    McGee L, Newcomb MD: General deviance syndrome: Expanded hierarchical evaluations at four ages from early adolescence to adulthood.Journal of Consulting & Clinical Psychology. 1992,60:766-76.CrossRefGoogle Scholar
  50. (50).
    Rotheram-Borus MJ, Reid H, Rosario M, Vanrossem R, Gillis R: Prevalence, course, and predictors of multiple problem behaviors among gay and bisexual male-adolescents.Developmental Psychology. 1995,31:75-5.CrossRefGoogle Scholar
  51. (51).
    Donohew L, Zimmerman R, Cuppa PS, et al.: Sensation seeking, impulsive decision-making, and risky sex: Implications for risk-taking and design of interventions.Personality & Individual Differences. 2000,28:1079-091.CrossRefGoogle Scholar
  52. (52).
    Balsam KF, Rothblum ED, Beauchaine TP: Victimization over the life span: A comparison of lesbian, gay, bisexual, and heterosexual siblings.Journal of Consulting & Clinical Psychology. 2005,73:477-87.CrossRefGoogle Scholar
  53. (53).
    Corliss HL, Cochran SD, Mays VM: Reports of parental maltreatment during childhood in a United States population-based survey of homosexual, bisexual, and heterosexual adults.Child Abuse and Neglect. 2002,26:1165-178.CrossRefPubMedGoogle Scholar
  54. (54).
    Morrison-Beedy D, Carey M, Tu X: Accuracy of Audio Computer-Assisted Self-Interviewing (ACASI) and self-administered questionnaires for the assessment of sexual behavior.AIDS and Behavior. 2006,10:1-2.CrossRefGoogle Scholar
  55. (55).
    Kissinger P, Rice J, Farley T, et al.: Application of computer-assisted interviews to sexual behavior research. American Journal of Epidemiology. 1999,149:950-54.PubMedGoogle Scholar
  56. (56).
    Cohen J, Cohen P, West SG, Aiken LS:Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences. Mahwah, NJ: Lawrence Erlbaum Associates, 2002.Google Scholar
  57. (57).
    Johnson WD, Hedges LV, Diaz RM: Interventions to modify sexual risk behaviors for preventing HIV infection in men who have sex with men.Cochrane Database of Systematic Reviews. 2003:CD001230.Google Scholar
  58. (58).
    Pedlow CT, Carey MP: HIV sexual risk-reduction interventions for youth: A review and methodological critique of randomized controlled trials.Behavior Modification. 2003,27:135-90.CrossRefPubMedGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2007

Authors and Affiliations

  • Brian Mustanski
    • 1
  • Robert Garofalo
    • 2
    • 3
  • Amy Herrick
    • 3
  • Geri Donenberg
    • 1
  1. 1.Institute for Juvenile Researchthe University of IllinoisChicago
  2. 2.Children’s Memorial Hospital/Northwestern University Feinberg School of MedicineUSA
  3. 3.Howard Brown Health CenterUSA

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