Psychosocial Health Conditions and HIV Prevalence and Incidence in a Cohort of Men Who have Sex with Men in Bangkok, Thailand: Evidence of a Syndemic Effect
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Men who have sex with men (MSM) in Bangkok may experience multiple psychosocial health conditions, such as substance use, suicidality, and a history of sexual abuse. These factors may contribute to HIV vulnerability in a syndemic way. A syndemic is defined as a number of synergistically interacting health conditions producing excess disease in a population. The objective of this study is to examine whether psychosocial health conditions among MSM have a syndemic association with HIV prevalence and HIV incidence. To do this, we evaluated psychosocial health conditions and their associations with unprotected sex, HIV prevalence and HIV incidence in a cohort of Thai MSM (N = 1,292). There was a positive and significant association between the number of psychosocial health conditions and increased levels of unprotected sex and HIV prevalence at study baseline. The number of psychosocial health conditions at baseline was also associated with increased HIV incidence during follow-up (no conditions, HIV incidence = 15.3 %; one to three conditions, 23.7 %; four to five conditions, 33.2 %). The number of psychosocial health conditions was positively associated with HIV risk behavior and HIV prevalence and incidence. Prevention efforts among MSM need to address the existence of multiple psychosocial health conditions and their synergy to effectively decrease the spread of HIV infection.
KeywordsSyndemics HIV/AIDS Men who have sex with men Thailand
The authors would like to thank the participants in the Bangkok MSM Cohort Study, the staff of the Silom Community Clinic, the HIV STD Research Program and the Thailand Ministry of Public Health—U.S. Centers for Disease Control and Prevention Collaboration for their contributions to the study. We would like to also acknowledge the leadership of the Thai Red Cross AIDS Research Center for granting the time needed to complete the study and to finalize the manuscript for publication. K. McCarthy was supported by the ASPPH/CDC Allan Rosenfield Global Health Fellowship and TE Guadamuz was supported by a Mentored Research Scientist Development Award from the U.S. National Institute of Mental Health (K01MH085567). The study was funded by the Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention. The findings and conclusions in this manuscript are those of the authors and do not necessary represent the views of the U.S. Centers for Disease Control and Prevention.
- 21.Stall R, Friedman MS, Catania JA. Interacting epidemics and gay men’s health: a theory of syndemic production among urban gay men. In: Wolitski RJ, Stall R, Valdiserri RO, editors. Unequal opportunity: health disparities affecting gay and bisexual men in the United States. Oxford: Oxford University Press; 2008. p. 251–74.Google Scholar
- 26.Guadamuz TE, Friedman, Marshal MP, Herrick AL, Lim SH, Wei C, Stall R. Health, sexual health, and syndemics: toward a better approach to STI and HIV preventive interventions for men who have sex with men (MSM) in the United States. In: Aral SO, Fenton KA, Lipshutz JA, editors. The new public health and STI/HIV prevention: personal, public, and health systems approaches. New York: Springer Science+Business Media, LLC; 2013.Google Scholar
- 37.Biello KB, Colby D, Closson E, Mimiaga MJ. The syndemic condition of psychosocial problems and HIV risk among male sex workers in Ho Chi Minh City, Vietnam. AIDS Behav. 2013 [Epub ahead of print].Google Scholar
- 38.Sungkanuparph S, Techasathit W, Utaipiboon C, Chasombat S, Bhakeecheep S, Leechawengwongs M, Ruxrungtham K, Phanuphak P. Thai national guidelines for antiretroviral therapy in HIV-1 infected adults and adolescents. Asian Biomed. 2010;4:515–28.Google Scholar
- 48.Sharan P, Levav I, Olifson S, de Francisco A, Saxena S, editors. Research capacity for mental health in low- and middle-income countries: results of a mapping project. Geneva: World Health Organization & Global Forum for Health Research; 2007.Google Scholar
- 53.Vongchak T, Kawichai S, Sherman S, Celentano DD, Sirisanthana T, Latkin C, Wiboonnatakul K, Srirak N, Jittiwutikarn J, Aramrattana A. The influence of Thailand’s 2003 ‘war on drugs’ policy on self-reported drug use among injection drug users in Chiang Mai. Thailand Int J Drug Policy. 2005;16:115–21.CrossRefGoogle Scholar
- 54.van Griensven F, Naorat S, Kilmarx PH, Jeeyapant S, Manopaiboon C, Chaikummao S, Jenkins RA, Uthaivoravit W, Wasinrapee P, Mock PA, Tappero JW. Palmtop-assisted self-interviewing for the collection of sensitive behavioral data: randomized trial with drug use urine testing. Am J Epidemiol. 2006;163:271–8.PubMedCrossRefGoogle Scholar