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Substance Use Disorders, Violence, Mental Health, and HIV: Differentiating a Syndemic Factor by Gender and Sexuality

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Abstract

This paper measures syndemic substance use disorder, violence, and mental health and compares the syndemic among HIV-infected heterosexual men, heterosexual women, and men who have sex with men (MSM). Data were from a sample of high needs substance-using, HIV-infected people in South Florida between 2010 and 2012 (n = 481). We used confirmatory factor analysis to measure a syndemic latent variable and applied measurement invariance models to identify group differences in the data structure of syndemic co-morbidities among heterosexual men, heterosexual women, and MSM. We found that variables used to measure the syndemic fit each sub-group, supporting that substance use disorder, violence, and mental health coincide in HIV-infected individuals. Heterosexual men and MSM demonstrated similar syndemic latent variable factor loadings, but significantly different item intercepts, indicating that heterosexual men had larger mean values on substance use disorder, anxiety, and depression than MSM. Heterosexual men and heterosexual women demonstrated significantly different syndemic variable factor loadings, indicating that anxiety and depression contribute more (and substance use contributes less) to the syndemic in heterosexual men compared to heterosexual women. MSM and heterosexual women demonstrated similar syndemic latent variable factor loadings and intercepts, but had significantly different factor residual variances indicating more variance in violent victimization and depression for MSM and more variance in stress for heterosexual women than what is captured by the observed syndemic indicators. Furthermore, heterosexual women had a larger syndemic factor mean than MSM, indicating that the syndemic burden is greater among heterosexual women than MSM. Our findings support that measurement invariance can elucidate differences in the syndemic to tailor interventions to sub-group needs.

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Acknowledgements

This research was funded by PHS Grant Number R01DA023157 (Surratt), T32DA023356 (Tsuyuki), K01 DA036447 (Pitpitan), K01DA036439 (Urada), and K01DA031593 (Stockman) from the National Institute on Drug Abuse (NIDA), R01HD077891-04S1 (Tsuyuki) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), L60MD003701 (Stockman) from the National Institute of Minority Health and Health Disparities, and K01AA025009 (Tsuyuki) from the National Institute of Alcohol Abuse and Alcoholism (NIAAA). NIDA, NICHD, NIMHD, and NIAAA had no further role in study design; in the collection, analysis and interpretation of data; in the writing of this report; or in the decision to submit the paper for publication.

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Authors and Affiliations

  1. Department of Medicine, University of California San Diego (UCSD), 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA

    Kiyomi Tsuyuki, Eileen V. Pitpitan & Jamila K. Stockman

  2. Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, FL, USA

    Maria A. Levi-Minzi, Steven P. Kurtz & Hilary L. Surratt

  3. School of Social Work, San Diego State University (SDSU), San Diego, USA

    Lianne A. Urada

  4. Center for Health Services Research, University of Kentucky, Lexington, KY, USA

    Hilary L. Surratt

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  1. Kiyomi Tsuyuki
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Correspondence to Kiyomi Tsuyuki.

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Kiyomi Tsuyuki, Eileen V. Pitpitan, Maria A. Levi-Minzi, Lianne A. Urada, Steven P. Kurtz, Jamila K. Stockman and Hilary L. Surratt declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional Review Boards of the University of Delaware (predecessor institution) and Nova Southeastern University and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. An NIH Certificate of Confidentiality was acquired and informed consent was obtained from every participant prior to interview.

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Tsuyuki, K., Pitpitan, E.V., Levi-Minzi, M.A. et al. Substance Use Disorders, Violence, Mental Health, and HIV: Differentiating a Syndemic Factor by Gender and Sexuality. AIDS Behav 21, 2270–2282 (2017). https://doi.org/10.1007/s10461-017-1841-3

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