AIDS and Behavior

, Volume 18, Issue 11, pp 2080–2088 | Cite as

Optimism and Education Buffer the Effects of Syndemic Conditions on HIV Status Among African American Men Who Have Sex with Men

  • Ann O’Leary
  • John B. JemmottIII
  • Robin Stevens
  • Scott Edward Rutledge
  • Larry D. Icard
Original Paper


The present study sought to replicate effects of the number of syndemic psychosocial health conditions on sexual risk behavior and HIV infection among a sample of high-risk African American men who have sex with men (MSM) and to identify resilience factors that may buffer these effects. We used baseline data from an HIV risk-reduction trial to examine whether a higher number of syndemic conditions was associated with higher rates of self-reported sexual risk behavior and HIV infection. Using logistic regression models, we tested for interactions between number of syndemic conditions and several potential resilience factors to identify buffering effects. Replicating previous studies, we found significant associations between numbers of syndemic conditions and higher rates of sexual risk behavior and HIV infection. Surprisingly, we also replicated a previous finding (Stall et al., Am J Public Health, 93(6):939–942, 2003) that the effects of syndemic burden on HIV status fell off at the highest levels of syndemic conditions. Among a variety of potential resilience factors, two—optimism and education—buffered the syndemic effect on HIV prevalence. This is, to our knowledge, the first paper to identify resilience factors buffering against syndemic effects among MSM. It also constitutes a significant contribution to the literature regarding prevention among black MSM. These results point to the need to identify HIV-positive black MSM and provide effective treatment for them and to develop interventions addressing both syndemic and resilience factors.


Syndemics African American men who have sex with men HIV Resilience Buffering 



The authors wish to recognize their funding source, the National Institute of Mental Health grant 1-R01-MH079736. We are grateful to many individuals who helped to bring this project to fruition, including Dr. Loretta S. Jemmott, Dr. Christopher Coleman, Janet Hsu, Brian Taylor, Mikia Croom, Pandora Woods, and Dennis Clegg. The findings and conclusions are those of the authors and do not necessarily reflect the official views of the Centers for Disease Control and Prevention.


  1. 1.
    Singer M. AIDS and the health crisis of the urban poor: the perspective of critical Medical Anthropology. Soc Sci Med. 1994;39(7):931–48.PubMedCrossRefGoogle Scholar
  2. 2.
    Singer M. A dose of drugs, a touch of violence, a case of AIDS: conceptualizing the SAVA syndemic. Free Inq. 1996;24(2):99–110.Google Scholar
  3. 3.
    Wallace R. A synergism of plagues. Environ Res. 1988;47:1–33.PubMedCrossRefGoogle Scholar
  4. 4.
    Parsons JT, Grov C, Golub SA. Sexual compulsivity, co-occurring psychosocial health problems, and HIV risk among gay and bisexual men: further evidence of a syndemic. Am J Public Health. 2012;102(1):156–62.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Stall RD, Mills TC, Williamson J, Hart T, Greenwood G, Paul J, Pollack L, Binson D, Osmond D, Catania JA. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. Am J Public Health. 2003;93(6):939–42.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Dyer TP, Shoptaw S, Guadamuz TE, Plankey M, Kao U, Ostrow D, Chmiel JS, Herrick A, Stall R. Application of syndemic theory to Black men who have sex with men in the Multicenter AIDS Cohort Study. J Urban Health. 2012;89(4):696–708.CrossRefGoogle Scholar
  7. 7.
    Mustanski B, Garofalo R, Herrick A, Donenberg G. 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. Ann Behav Med. 2007;34(1):37–45.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Jie W, Ciyong L, Xueqing D, Hui W, Lingyao H. Syndemic of psychosocial problems places the MSM (men who have sex with men) population at greater risk of HIV infection. PLoS One. 2012;7(3):e32312.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Brennan J, Kuhns LM, Johnson AK, Belzer M, Wilson EC, Garofalo R. Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalization. Am J Public Health. 2012;102(9):1751–7.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Senn TE, Carey MP, Vanable PA. The intersection of violence, substance use, depression, and STDs: testing of a syndemic pattern among patients attending an urvan STD clinic. J Natl Med Assoc. 2010;102(7):614–20.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Bruce D, Harper GW. Operating without a safety net: gay male adolescents and emerging adults’ experiences of marginalization and migration, and implications for theory of syndemic production of health disparities. Health Educ Behar. 2011;38(4):367–78.CrossRefGoogle Scholar
  12. 12.
    Herrick AL, Lim SH, Wei C, Smith H, Guadamuz T, Friedman MS, Stall R. Resilience as an untapped resource in behavioral intervention design for gay men. AIDS Behav. 2011;15:S25–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Herrick AL, Stall RD, Goldhammer H, Egan JE, Mayer KH. Resilience as a research framework and as a cornerstone of prevention research for gay and bisexual men: theory and evidence. AIDS Behav. 2013; doi: 10.1007/s10461-012-0384-x.PubMedPubMedCentralGoogle Scholar
  14. 14.
    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(3):193–205.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Jemmott JB, et al. (in preparation). Efficacy of a one-on-one HIV/STI risk reduction intervention for African American men who have sex with men: a randomized controlled trial.Google Scholar
  16. 16.
    Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.CrossRefGoogle Scholar
  17. 17.
    Wyatt GE, Lawrence J, Vodounon A, et al. The Wyatt Sex History Questionnaire: a structured interview for female sexual history taking. J Child Sex Abuse. 1992;1:51–68.CrossRefGoogle Scholar
  18. 18.
    Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984;252:1905–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Peters RH, Greenbaum PE, Steinberg ML, et al. Effectiveness of screening instruments in detecting substance use disorders among prisoners. J Subst Abuse Treat. 2000;18:349–58.PubMedCrossRefGoogle Scholar
  20. 20.
    Lowmaster SE, Morey LC, Baker L, Hopwood CJ. Structure, reliability, and predictive validity of the Texas Christian University correctional residential self-rating form at intake in a residential substance abuse treatment facility. J Subst Abuse Treat. 2010;39(2):180–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Strauss M, Hamby S, Boney-McKoy S, et al. The revised conflict tactics scale (CTS2). J Fam Issues. 1996;17:283–316.CrossRefGoogle Scholar
  22. 22.
    Cohen S, Doyle WJ, Skoner DP, Rabin BS, Gwaltney JM. Social ties and susceptibility to the common cold. JAMA. 1997;277(24):1940–4. doi: 10.1001/Jama.277.24.1940.PubMedCrossRefGoogle Scholar
  23. 23.
    Pew Forum on Religion and Public Life. U.S. religious landscape survey, religious affiliation: diverse and dynamic. (2008). Accessed Feb 2008.
  24. 24.
    Sellers RM, Rowley SAJ, Chavous TM, Shelton JN, Smith MA. Multidimensional inventory of black identity: a preliminary investigation of reliability and construct validity. J Pers Soc Psychol. 1997;73(4):805–15.CrossRefGoogle Scholar
  25. 25.
    Brown JS, Rawlinson ME, Hilles NC. Life satisfaction and chronic disease: exploration of a theoretical model. Med Care. 1981;29:1136–46.CrossRefGoogle Scholar
  26. 26.
    Cantril H. The pattern of human concerns. New Brunswick: Rutgers University Press; 1965.Google Scholar
  27. 27.
    Marks G, Millett GA, Bingham T, Bond L, Lauby J, Liau A, Murrill CS, Stueve A. Understanding differences in HIV sexual transmission among Latino and Black men who have sex with men: the Brothers y Hermanos Study. AIDS Behav. 2009;13:682–90.PubMedCrossRefGoogle Scholar
  28. 28.
    Philadelphia Department of Public Health. Surveillance report, 2011 and construct validity. J Pers Soc Psychol. 2013;73(4):805–15. doi: 10.1037/0022-3514.73.4.805.Google Scholar
  29. 29.
    Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985;98(2):310–57.PubMedCrossRefGoogle Scholar
  30. 30.
    Rasmussen HN, Scheier M, Greenhouse JB. Optimism and physical health: a meta-analytic review. Ann Behav Med. 2013;37(3):239–56.CrossRefGoogle Scholar
  31. 31.
    Centers for Disease Control and Prevention. HIV prevalence, unrecognized infection, and HIV testing among men who have sex with men—five U.S. cities, June 2004–April 2005. MMWR. 2005;54(24):597–601.Google Scholar
  32. 32.
    Centers for Disease Control and Prevention. Prevalence and awareness of HIV infection among men who have sex with men—21 cities, United States, 2008. MMWR. 2010;59(37):1201–7.Google Scholar
  33. 33.
    Millet GA, Peterson JL, Wolitski RJ, Stall R. Greater risk for HIV infection of black men who have sex with men: a critical literature review. Am J Public Health. 2006;96:1007–19.CrossRefGoogle Scholar
  34. 34.
    Paul JP, Catania J, Pollack L, Stall R. Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: the Urban Men’s Health Study. Child Abuse Negl. 2001;25:557–84.PubMedCrossRefGoogle Scholar
  35. 35.
    Greenwood GL, Reif MV, Huang B, Pollack LM, Canchola JA, Catania JA. Battering victimization among a probability=based sample of men who have sex with men. Am J Public Health. 2002;92:1964–9.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Stall R, Paul JP, Greenwood G, Pollack LM, Bein E, Crosby GM, Mills TC, Binson D, Coates TJ, Catania JA. Alcohol use, drug use and alcohol-related problems among men who have sex with men: the Urban Men’s Health Study. Addiction. 2001;96:1589–601.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York (outside the USA) 2014

Authors and Affiliations

  • Ann O’Leary
    • 1
  • John B. JemmottIII
    • 2
  • Robin Stevens
    • 3
  • Scott Edward Rutledge
    • 4
  • Larry D. Icard
    • 4
  1. 1.Division of HIV/AIDS PreventionCenters for Disease Control and PreventionAtlantaUSA
  2. 2.Department of Psychiatry, Perelman School of Medicine and Annenberg School for CommunicationUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of Childhood StudiesRutgers UniversityCamdenUSA
  4. 4.School of Social WorkTemple UniversityPhiladelphiaUSA

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