AIDS and Behavior

, Volume 17, Issue 2, pp 662–673 | Cite as

Measurement Model Exploring a Syndemic in Emerging Adult Gay and Bisexual Men

  • Perry N. Halkitis
  • Robert W. Moeller
  • Daniel E. Siconolfi
  • Erik D. Storholm
  • Todd M. Solomon
  • Kristen L. Bub
Original Paper


The current study was designed to develop a better understanding of the nature of the relationships between mental health burden, drug use, and unprotected sexual behavior within a sample of emerging adult gay and bisexual men, ages 18–19 (N = 598) and to test a theory of syndemics using structural equation modeling. Participants were actively recruited from community-based settings and the Internet for participation in a seven-wave cohort study. Data for participant characteristics and mental health were collected via computer-assisted survey, while drug use and unprotected sex behaviors for the month prior to assessment were collected via a calendar-based technique. Using the baseline data, we developed and tested structural equation models for mental health burden, drug use, and unprotected sex and also tested a second-order model for a single syndemic. First-order measurement models for each of the three epidemics were successfully identified using observed data. Tests of a second-order model seeking to explain the three epidemics as a single syndemic fit poorly. However, a second-order construct comprised of mental health burden and drug use fit the data well and was highly associated with the first-order construct of unprotected sex. The findings advance a theory of syndemics and suggest that in order to be maximally effective both HIV prevention and HIV care must be delivered holistically such that sexual risk behaviors are addressed in relation to, and in sync with, the drug use and mental health of the individual.


Gay and bisexual men Emerging adulthood Syndemic HIV Structural equation modeling 


El estudio actual fue diseñado para desarrollar un mejor entendimiento de la naturaleza de la relación entre la salud mental, el uso de drogas y el comportamiento sexual sin protección en una muestra de hombres gay y bisexuales al inicio de la adultez, en edades entre los 18–19 años (N = 598) y para probar una teoría sindémica utilizando modelos de ecuaciones estructurales. Los participantes fueron reclutados activamente en la comunidad y en el Internet para participar en un estudio de cohorte 7 veces. Los datos acerca de las características de los participantes y salud mental fueron colectados por medio de una encuesta asistida por computadora, mientras que el uso de drogas y el comportamiento sexual sin protección en el mes anterior a la valoración fueron colectados por medio de una técnica basada en calendario. Usando los datos de base, nosotros desarrollamos y probamos modelos de ecuaciones estructurales para la salud mental, el uso de drogas, y el comportamiento sexual sin protección; y también probamos un modelo de segundo-orden para una sola sindemia. Los modelos de medición de primer-orden para cada una de las tres epidemias fueron identificados con éxito utilizando los datos observados. Las pruebas de un modelo de segundo-orden buscando explicar las tres epidemias como una sola sindemia se ajustaron pobremente a los datos. Sin embargo, una construcción de segundo-orden de la salud mental y el uso de drogas se ajustó a los datos adecuadamente y fue altamente asociada con la construcción de primer-orden del comportamiento sexual sin protección. Los hallazgos avanzan una teoría sindémica y sugieren que para ser máximamente eficiente tanto la prevención del VIH como el cuidado del VIH deben de ser suministrados de manera integral de forma que los comportamientos sexuales de riesgo sean abordados en relación a, y en coordinación con, el uso de drogas y la salud mental de los individuos.



This study was funded by the National Institute on Drug Abuse, Contract #R01DA025537 awarded to Perry N. Halkitis.


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Perry N. Halkitis
    • 1
    • 2
  • Robert W. Moeller
    • 1
  • Daniel E. Siconolfi
    • 1
  • Erik D. Storholm
    • 1
  • Todd M. Solomon
    • 1
  • Kristen L. Bub
    • 3
  1. 1.Center for Health, Identity, Behavior & Prevention Studies, The Steinhardt School of Culture, Education, and Human DevelopmentNew York UniversityNew YorkUSA
  2. 2.Division of General Internal Medicine, Langone School of MedicineNew York UniversityNew YorkUSA
  3. 3.College of Human SciencesAuburn UniversityAuburnUSA

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