AIDS and Behavior

, Volume 22, Issue 12, pp 3962–3970 | Cite as

Understanding HIV Risk Behaviors Among Young Men in South Africa: A Syndemic Approach

  • Chukwuemeka N. OkaforEmail author
  • Joan Christodoulou
  • Jason Bantjes
  • Tembinkosi Qondela
  • Jackie Stewart
  • Steve Shoptaw
  • Mark Tomlinson
  • Mary Jane Rotherman-Borus
Original Paper


Young men in South Africa experience several adverse socio-structural and psychosocial factors that may contribute HIV risk behaviors. This study applied a syndemic framework to explore whether these syndemic factors are interconnected and work in synergy to increase HIV risk behaviors. Five syndemic factors were assessed including: binge drinking, polydrug use, depressive symptoms, violence and food insecurity on two HIV risk behaviors: multiple sex partners and transactional sex. Participants were (N = 1233) young men aged 18–29 years from a township in Cape Town, South Africa. Bivariate logistic regression analysis demonstrated that many of the syndemic factors were related to one another. Pairwise interactions (on an additive scale) among the syndemic factors revealed significant positive interactions between binge drinking and violence on greater odds of reporting multiple sex partners (aOR = 5.10, 95% CI 3.10, 8.29; p = < .001) compared to reporting neither factor. Also, food insecurity and violence (aOR = 2.89, 95% CI 1.63, 5.11; p = < .001) as well as food insecurity and polydrug use (aOR = 2.73, 95% CI 1.54, 4.84; p = < .001) were significantly associated with greater odds of transactional sex compared to reporting neither factor. Our findings highlight a synergistic relationship between some adverse socio-structural and psychosocial factors on HIV risk behaviors. HIV prevention programs that address multiple syndemic factors simultaneously may achieve greater impact on HIV risk reduction.


HIV risk HIV risk behaviors Syndemics Alcohol South Africa 



This project was supported by the National Institute on Drug Abuse (R34DA030311) and the National Research Foundation, South Africa. CNO is supported by the UCLA Postdoctoral Fellowship Training Program in Global HIV Prevention Research (T32MH080634; PIs: Currier and Gorbach). SS is supported by NIMH P30 058107—CHIPTS UCLA CFAR grant AI028697. MT is supported by the National Research Foundation, South Africa and is a Lead Investigator of the Centre of Excellence in Human Development, University Witwatersrand, South Africa.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

The Institutional Review Boards at UCLA and Stellenbosch University approved all aspects of the study.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Chukwuemeka N. Okafor
    • 1
    • 4
    Email author
  • Joan Christodoulou
    • 2
  • Jason Bantjes
    • 3
  • Tembinkosi Qondela
    • 3
  • Jackie Stewart
    • 3
  • Steve Shoptaw
    • 4
  • Mark Tomlinson
    • 3
  • Mary Jane Rotherman-Borus
    • 5
  1. 1.Division of Infectious Diseases, Department of Medicine, David Geffen School of MedicineUniversity of California, Los AngelesLos AngelesUSA
  2. 2.Department of Psychiatry & Biobehavioral Sciences, Semel InstituteUniversity of California, Los AngelesLos AngelesUSA
  3. 3.Department of PsychologyStellenbosch UniversityStellenboschSouth Africa
  4. 4.Department of Family Medicine, David Geffen School of MedicineUniversity of California, Los AngelesLos AngelesUSA
  5. 5.UCLA Center for HIV Identification, Prevention and Treatment ServicesUniversity of California, Los AngelesLos AngelesUSA

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