Archives of Sexual Behavior

, Volume 48, Issue 4, pp 1159–1170 | Cite as

Longitudinal Effects of Syndemics on HIV-Positive Sexual Minority Men’s Sexual Health Behaviors

  • Audrey HarknessEmail author
  • Sierra A. Bainter
  • Conall O’Cleirigh
  • Christopher Albright
  • Kenneth H. Mayer
  • Steven A. Safren
Original Paper


This study examined the longitudinal effects of co-occurring psychosocial concerns, or syndemics, on HIV-positive sexual minority men’s likelihood of engaging in serodiscordant condomless anal sex (CAS), a health behavior with implications for personal and public health. Participants included 390 HIV-positive sexual minority men from two prior secondary prevention trials. Over the course of the 1-year data collection period (up to 5 observations per participant), participants completed self-report measures of CAS, as well as six syndemic factors: post-traumatic stress disorder, childhood sexual abuse, depression, anxiety, alcohol abuse, and polysubstance/stimulant use. We employed multilevel modeling to examine the longitudinal additive effect of syndemics on serodiscordant CAS (binary) over the 1-year period. The number of syndemic conditions was a significant predictor of CAS, with each additional syndemic associated with 1.41 greater odds of CAS (p = .0004; 95% CI [1.16, 1.70]). Both the between-person (p = .0121, 95% CI [1.07, 1.69]) and within-person (p = .01, 95% CI [1.11, 2.10]) effects of syndemics were significant predictors, showing that an increase in the number of syndemic conditions across person and time both increased odds of CAS. Interventions addressing HIV-positive sexual minority men’s sexual health behaviors should address the potential impact of co-occurring psychosocial concerns that affect these behaviors. This will benefit this population’s personal sexual health and reduce transmission of HIV and STIs among sexual minority men.


HIV/AIDS Men who have sex with men/MSM Syndemic Sexual behavior Secondary HIV prevention Sexual orientation 



This research was supported in part by HRSA (H97HA01293) and NIMH (5R01MH068746) awarded to Drs. Kenneth H. Mayer and Steven A. Safren. Some of the author time was supported by NIDA (9K24DA040489) awarded to Dr. Steven A. Safren.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

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

Supplementary material

10508_2018_1329_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 kb)


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Authors and Affiliations

  1. 1.Department of PsychologyUniversity of MiamiCoral GablesUSA
  2. 2.The Fenway InstituteFenway Community HealthBostonUSA
  3. 3.Department of PsychiatryMassachusetts General Hospital/Harvard Medical SchoolBostonUSA
  4. 4.Department of MedicineBeth Israel Deaconess Medical CenterBostonUSA
  5. 5.Department of MedicineHarvard Medical SchoolBostonUSA

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