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AIDS and Behavior

, Volume 18, Issue 11, pp 2089–2096 | Cite as

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

  • T. E. Guadamuz
  • K. McCarthy
  • W. Wimonsate
  • W. Thienkrua
  • A. Varangrat
  • S. Chaikummao
  • A. Sangiamkittikul
  • R. D. Stall
  • F. van Griensven
Original Paper

Abstract

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.

Keywords

Syndemics HIV/AIDS Men who have sex with men Thailand 

Notes

Acknowledgments

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.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • T. E. Guadamuz
    • 1
    • 2
  • K. McCarthy
    • 3
  • W. Wimonsate
    • 3
  • W. Thienkrua
    • 3
  • A. Varangrat
    • 3
  • S. Chaikummao
    • 3
  • A. Sangiamkittikul
    • 3
  • R. D. Stall
    • 2
  • F. van Griensven
    • 4
    • 5
  1. 1.Department of Society and Health, Faculty of Social Sciences and HumanitiesMahidol UniversityNakorn PathomThailand
  2. 2.Department of Behavioral and Community Health SciencesUniversity of Pittsburgh Graduate School of Public HealthPittsburghUSA
  3. 3.Thailand Ministry of Public Health—U.S. Centers for Disease Control and Prevention CollaborationNonthaburiThailand
  4. 4.Thai Red Cross AIDS Research Center and HIV Netherlands Australia Thailand Research CollaborationBangkokThailand
  5. 5.Division of Preventive Medicine and Public HealthUniversity of California at San FranciscoSan FranciscoUSA

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