Skip to main content

Advertisement

SpringerLink
Log in

Syndemic Profiles and Sexual Minority Men’s HIV-Risk Behavior: A Latent Class Analysis

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

Syndemic theory posits that “syndemic conditions” (e.g., alcohol misuse, polydrug use, suicidality) co-occur among sexual minority men and influence HIV-risk behavior, namely HIV acquisition and transmission risk. To examine how four syndemic conditions cluster among sexual minority men and contribute to HIV-risk behavior, we conducted latent class analysis (LCA) to: (1) classify sexual minority men (n = 937) into subgroups based on their probability of experiencing each syndemic condition; (2) examine the demographic (e.g., race/ethnicity) and social status (e.g., level of socioeconomic distress) characteristics of the most optimally fitting four syndemic classes; (3) examine between-group differences in HIV-risk behavior across classes; and (4) use syndemic class membership to predict HIV-risk behavior with sexual minority men reporting no syndemic conditions as the reference group. The four classes were: (1) no syndemic, (2) alcohol misuse and polydrug use syndemic, (3) polydrug use and HIV syndemic, and (4) alcohol misuse. HIV-risk behavior differed across these latent classes. Demographic and social status characteristics predicted class membership, suggesting that syndemic conditions disproportionately co-occur in vulnerable subpopulations of sexual minority men, such as those experiencing high socioeconomic distress. When predicting HIV-risk behavior, men in the polydrug use and HIV syndemic class were more likely (Adjusted Risk Ratio [ARR] = 2.93, 95% CI: 1.05, 8.21) and men in the alcohol misuse class were less likely (ARR = 0.17, 95% CI: 0.07, 0.44) to report HIV-risk behavior than were men in the no syndemic class. LCA represents a promising methodology to inform the development and delivery of tailored interventions targeting distinct combinations of syndemic conditions to reduce sexual minority men’s HIV-risk behavior.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Baams, L., Grossman, A. H., & Russell, S. T. (2015). Minority stress and mechanisms of risk for depression and suicidal ideation among lesbian, gay, and bisexual youth. Developmental Psychology, 51(5), 680–696.

    Article  Google Scholar 

  • Bakk, Z., Tekle, F. B., & Vermunt, J. K. (2013). Estimating the association between latent class membership and external variables using bias-adjusted three-step approaches. Sociological Methodology, 43(1), 272–311.

    Article  Google Scholar 

  • Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society Series B. Methodological, 57, 289–300.

    Google Scholar 

  • Blosnich, J., & Bossarte, R. (2012). Drivers of disparity: Differences in socially based risk factors of self-injurious and suicidal behaviors among sexual minority college students. Journal of American College Health, 60(2), 141–149.

    Article  PubMed  Google Scholar 

  • Boeri, M. W., Sterk, C. E., Bahora, M., & Elifson, K. W. (2008). Poly-drug use among ecstasy users: Separate, synergistic, and indiscriminate patterns. Journal of Drug Issues, 38(2), 517–541.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bohn, M. J., Babor, T. F., & Kranzler, H. R. (1995). The Alcohol Use Disorders Identification Test (AUDIT): Validation of a screening instrument for use in medical settings. Journal of Studies on Alcohol, 56(4), 423–432.

    Article  PubMed  Google Scholar 

  • Bond, K. T., Yoon, I. S., Houang, S. T., Downing, M. J., Grov, C., & Hirshfield, S. (2019). Transactional sex, substance use, and sexual risk: comparing pay direction for an internet-based US sample of men who have sex with men. Sexuality Research and Social Policy, 16(3), 255–267.

    Article  PubMed  Google Scholar 

  • Boone, M. R., Cook, S. H., & Wilson, P. (2013). Substance use and sexual risk behavior in HIV- positive men who have sex with men: An episode-level analysis. AIDS and Behavior, 17(5), 1883–1887.

    Article  PubMed  Google Scholar 

  • Bränström, R., & Pachankis, J. E. (2018). Sexual orientation disparities in the co-occurrence of substance use and psychological distress: a national population-based study (2008–2015). Social Psychiatry and Psychiatric Epidemiology, 53(4), 403–412.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brennan, D. J., Ross, L. E., Dobinson, C., Veldhuizen, S., & Steele, L. S. (2010). Men’s sexual orientation and health in Canada. Canadian Journal of Public Health, 101, 255–258.

    Article  PubMed  PubMed Central  Google Scholar 

  • Burton, C. L., Clark, K. A., & Pachankis, J. E. (2020). Risk from within: Intraminority gay community stress and sexual risk-taking among sexual minority men. Annals of Behavioral Medicine, 54, 703–712.

    Article  PubMed  PubMed Central  Google Scholar 

  • Carrico, A. W., Neilands, T. B., & Johnson, M. O. (2010). Suicidal ideation is associated with HIV transmission risk in men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 54(4), 450–462.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention. (2015). Sexually transmitted diseases treatment guidelines, 2015. Morbidity and Mortality Weekly Report, 64(3), 1–134.

    Google Scholar 

  • Chakrapani, V., Willie, T. C., Shunmugam, M., & Kershaw, T. S. (2019). Syndemic classes, stigma, and sexual risk among transgender women in India. AIDS and Behavior, 23(6), 1518–1529.

    Article  PubMed  Google Scholar 

  • Cloete, A., Simbayi, L. C., Kalichman, S. C., Strebel, A., & Henda, N. (2008). Stigma and discrimination experiences of HIV-positive men who have sex with men in Cape Town, South Africa. AIDS Care, 20(9), 1105–1110.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cochran, S. D., Ackerman, D., Mays, V. M., & Ross, M. W. (2004). Prevalence of non-medical drug use and dependence among homosexually active men and women in the US population. Addiction, 99(8), 989–998.

    Article  PubMed  PubMed Central  Google Scholar 

  • Collins, L. M., & Lanza, S. T. (2010). Latent class and latent transition analysis: With applications in the social, behavioral, and health sciences. New York: Wiley.

    Google Scholar 

  • Conigrave, K. M., Saunders, J. B., & Reznik, R. B. (1995). Predictive capacity of the AUDIT questionnaire for alcohol-related harm. Addiction, 90, 1479–1485.

    Article  PubMed  Google Scholar 

  • Corliss, H. L., Rosario, M., Wypij, D., Fisher, L. B., & Austin, S. B. (2008). Sexual orientation disparities in longitudinal alcohol use patterns among adolescents: Findings from the Growing Up Today Study. Archives of Pediatrics and Adolescent Medicine, 162(11), 1071–1078.

    Article  PubMed  Google Scholar 

  • Cramer, R. J., Colbourn, S. L., Gemberling, T. M., Graham, J., & Stroud, C. H. (2015). Substance-related coping, HIV-related factors, and mental health among an HIV-positive sexual minority community sample. AIDS Care, 27(9), 1063–1068.

    Article  PubMed  Google Scholar 

  • Cuevas, A. G., Chen, R., Slopen, N., Thurber, K. A., Wilson, N., Economos, C., & Williams, D. R. (2020). Assessing the role of health behaviors, socioeconomic status, and cumulative stress for racial/ethnic disparities in obesity. Obesity, 28(1), 161–170.

    Article  PubMed  Google Scholar 

  • Dangerfield, D. T., Carmack, C. C., Gilreath, T. D., & Duncan, D. T. (2018). Latent classes of sexual positioning practices and sexual risk among men who have sex with men in Paris. France. AIDS and Behavior, 22(12), 4001–4008.

    Article  PubMed  Google Scholar 

  • Daskalopoulou, M., Rodger, A., Phillips, A. N., Sherr, L., Speakman, A., Collins, S., … Wilkins, E. (2014). Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: Results from the cross-sectional ASTRA Study. The Lancet HIV, 1(1), e22–e31. https://doi.org/10.1016/S2352-3018(14)70001-3.

    Article  PubMed  Google Scholar 

  • De Graaf, R., Sandfort, T. G., & ten Have, M. (2006). Suicidality and sexual orientation: Differences between men and women in a general population-based sample from the Netherlands. Archives of Sexual Behavior, 35(3), 253–262.

    Article  PubMed  Google Scholar 

  • Derogatis, L. R., & Melisaratos, N. (1983). The Brief Symptom Inventory: An introductory report. Psychological Medicine, 13(3), 595–605.

    Article  PubMed  Google Scholar 

  • Dias, J. G. (2006). Latent class analysis and model selection. In P. D. M. Spiliopoulou, P. D. R. Kruse, D. C. Borgelt, J.-P. D. A. Nürnberger, & P. D. W. Gaul (Eds.), From data and information analysis to knowledge engineering (pp. 95–102). Berlin: Springer.

    Chapter  Google Scholar 

  • Dowshen, N., Binns, H. J., & Garofalo, R. (2009). Experiences of HIV-related stigma among young men who have sex with men. AIDS Patient Care and STDs, 23(5), 371–376.

    Article  PubMed  PubMed Central  Google Scholar 

  • Earnshaw, V. A., Eaton, L. A., Collier, Z. K., Watson, R. J., Maksut, J. L., Rucinski, K. B., … Kalichman, S. C. (2020). HIV stigma, depressive symptoms, and substance use. AIDS Patient Care and STDs, 34(6), 275–280.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ferlatte, O., Salway, T., Oliffe, J. L., & Trussler, T. (2017). Stigma and suicide among gay and bisexual men living with HIV. AIDS Care, 29(11), 1346–1350.

    Article  PubMed  Google Scholar 

  • Friedman, M. R., Bukowski, L., Eaton, L. A., Matthews, D. D., Dyer, T. V., Siconolfi, D., & Stall, R. (2019). Psychosocial health disparities among black bisexual men in the US: Effects of sexuality nondisclosure and gay community support. Archives of Sexual Behavior, 48(1), 213–224.

    Article  PubMed  Google Scholar 

  • Gates, G. J. (2017). In US, more adults identifying as LGBT. Gallup Reports. Retrieved from http://www.gallup.com/poll/201731/lgbt-identification-rises.aspx

  • Greenwood, G. L., White, E. W., Page-Shafer, K., Bein, E., Osmond, D. H., Paul, J., & Stall, R. D. (2001). Correlates of heavy substance use among young gay and bisexual men: The San Francisco Young Men’s Health Study. Drug and Alcohol Dependence, 61(2), 105–112.

    Article  PubMed  Google Scholar 

  • Halkitis, P. N., Kapadia, F., Bub, K. L., Barton, S., Moreira, A. D., & Stults, C. B. (2015). A longitudinal investigation of syndemic conditions among young gay, bisexual, and other MSM: The P18 Cohort Study. AIDS and Behavior, 19(6), 970–980.

    Article  PubMed  PubMed Central  Google Scholar 

  • Halkitis, P. N., Moeller, R. W., Siconolfi, D. E., Storholm, E. D., Solomon, T. M., & Bub, K. L. (2013). Measurement model exploring a syndemic in emerging adult gay and bisexual men. AIDS and Behavior, 17(2), 662–673.

    Article  PubMed  PubMed Central  Google Scholar 

  • Halkitis, P. N., Pollock, J. A., Pappas, M. K., Dayton, A., Moeller, R. W., Siconolfi, D., & Solomon, T. (2011). Substance use in the MSM population of New York City during the era of HIV/AIDS. Substance Use and Misuse, 46(2–3), 264–273.

    Article  PubMed  Google Scholar 

  • Hall, H. I., An, Q., Tang, T., Song, R., Chen, M., Green, T., & Kang, J. (2015). Prevalence of diagnosed and undiagnosed HIV infection-United States, 2008–2012. Morbidity and Mortality Weekly Report, 64(24), 657–662.

    PubMed  PubMed Central  Google Scholar 

  • Hart, T. A., Noor, S. W., Adam, B. D., Vernon, J. R., Brennan, D. J., Gardner, S., … Myers, T. (2017). Number of psychosocial strengths predicts reduced HIV sexual risk behaviors above and beyond syndemic problems among gay and bisexual men. AIDS and Behavior, 21(10), 3035–3046.

    Article  PubMed  Google Scholar 

  • Hatzenbuehler, M. L., & Pachankis, J. E. (2016). Stigma and minority stress as social determinants of health among lesbian, gay, bisexual, and transgender youth: Research evidence and clinical implications. Pediatric Clinics, 63(6), 985–997.

    PubMed  Google Scholar 

  • Herrick, A., Stall, R., Egan, J., Schrager, S., & Kipke, M. (2014). Pathways towards risk: Syndemic conditions mediate the effect of adversity on HIV risk behaviors among young men who have sex with men (YMSM). Journal of Urban Health, 91(5), 969–982.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hirshfield, S., Schrimshaw, E. W., Stall, R. D., Margolis, A. D., Downing, M. J., Jr., & Chiasson, M. A. (2015). Drug use, sexual risk, and syndemic production among men who have sex with men who engage in group sexual encounters. American Journal of Public Health, 105(9), 1849–1858.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hottes, T. S., Bogaert, L., Rhodes, A. E., Brennan, D. J., & Gesink, D. (2016). Lifetime prevalence of suicide attempts among sexual minority adults by study sampling strategies: A systematic review and meta-analysis. American Journal of Public Health, 106, e1–e12.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ibañez, G. E., Purcell, D. W., Stall, R., Parsons, J. T., & Gómez, C. A. (2005). Sexual risk, substance use, and psychological distress in HIV-positive gay and bisexual men who also inject drugs. AIDS, 19, S49–S55.

    Article  PubMed  Google Scholar 

  • IBM Corp. (2016). IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: Author.

    Google Scholar 

  • Irwin, T. W., Morgenstern, J., Parsons, J. T., Wainberg, M., & Labouvie, E. (2006). Alcohol and sexual HIV risk behavior among problem drinking men who have sex with men: An event level analysis of timeline followback data. AIDS and Behavior, 10(3), 299–307.

    Article  PubMed  Google Scholar 

  • King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D., & Nazareth, I. (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry, 8(1), 70. https://doi.org/10.1186/1471-244X-8-70.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kurtz, S. P., Buttram, M. E., Surratt, H. L., & Stall, R. D. (2012). Resilience, syndemic factors, and serosorting behaviors among HIV-positive and HIV-negative substance-using MSM. AIDS Education and Prevention, 24(3), 193–205.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lanza, S. T., & Rhoades, B. L. (2013). Latent class analysis: An alternative perspective on subgroup analysis in prevention and treatment. Prevention Science, 14(2), 157–168.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lelutiu-Weinberger, C., Pachankis, J. E., Gamarel, K. E., Surace, A., Golub, S. A., & Parsons, J. T. (2015). Feasibility, acceptability, and preliminary efficacy of a live-chat social media intervention to reduce HIV risk among young men who have sex with men. AIDS and Behavior, 19(7), 1214–1227.

    Article  PubMed  PubMed Central  Google Scholar 

  • Levy, M. E., Wilton, L., Phillips, G., Glick, S. N., Kuo, I., Brewer, R. A., … Magnus, M. (2014). Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States. AIDS and Behavior, 18(5), 972–996.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lyons, A., Pitts, M., & Grierson, J. (2013). Methamphetamine use in a nationwide online sample of older Australian HIV-positive and HIV-negative gay men. Drug and Alcohol Review, 32(6), 603–610.

    Article  PubMed  Google Scholar 

  • Lyons, A., Pitts, M., Grierson, J., Thorpe, R., & Power, J. (2010). Ageing with HIV: health and psychosocial well-being of older gay men. AIDS Care, 22(10), 1236–1244.

    Article  PubMed  Google Scholar 

  • Maulsby, C., Millett, G., Lindsey, K., Kelley, R., Johnson, K., Montoya, D., & Holtgrave, D. (2014). HIV among black men who have sex with men (MSM) in the United States: A review of the literature. AIDS and Behavior, 18(1), 10–25.

    Article  PubMed  Google Scholar 

  • McCabe, S. E., Bostwick, W. B., Hughes, T. L., West, B. T., & Boyd, C. J. (2010). The relationship between discrimination and substance use disorders among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 100(10), 1946–1952.

    Article  PubMed  PubMed Central  Google Scholar 

  • McKee, G., Butt, Z. A., Wong, S., Salway, T., Gilbert, M., Wong, J., … Krajden, M. (2018). Syndemic characterization of HCV, HBV, and HIV co-infections in a large population based cohort study. EClinicalMedicine, 4, 99–108.

    Article  PubMed  Google Scholar 

  • Mereish, E. H., O’Cleirigh, C., & Bradford, J. B. (2014). Interrelationships between LGBT- based victimization, suicide, and substance use problems in a diverse sample of sexual and gender minorities. Psychology, Health & Medicine, 19(1), 1–13.

    Article  Google Scholar 

  • Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.

    Article  PubMed  PubMed Central  Google Scholar 

  • Miller, R. & Appel, C. (2010). Self-evaluation of drug use. Retrieved from http://casaa.unm.edu/inst/Self Evaluation of Drug Use.pdf.

  • Millett, G. A., Peterson, J. L., Flores, S. A., Hart, T. A., Jeffries, W. L., 4th, Wilson, P. A., … Remis, R. S. (2012). Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: A meta-analysis. The Lancet, 380(9839), 341–348.

    Article  Google Scholar 

  • Mimiaga, M. J., O’Cleirigh, C., Biello, K. B., Robertson, A. M., Safren, S. A., Coates, T. J., … Mayer, K. H. (2015). The effect of psychosocial syndemic production on 4-year HIV incidence and risk behavior in a large cohort of sexually active men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 68(3), 329–336.

    Article  PubMed  Google Scholar 

  • Mimiaga, M. J., Reisner, S. L., Vanderwarker, R., Gaucher, M. J., O’Connor, C. A., Medeiros, M. S., & Safren, S. A. (2008). Polysubstance use and HIV/STD risk behavior among Massachusetts men who have sex with men accessing Department of Public Health mobile van services: Implications for intervention development. AIDS Patient Care and STDs, 22(9), 745–751.

    Article  PubMed  Google Scholar 

  • Morgan, G. B. (2015). Mixed mode latent class analysis: An examination of fit index performance for classification. Structural Equation Modeling: A Multidisciplinary Journal, 22(1), 76–86.

    Article  Google Scholar 

  • Mustanski, B., Andrews, R., Herrick, A., Stall, R., & Schnarrs, P. W. (2014). A syndemic of psychosocial health disparities and associations with risk for attempting suicide among young sexual minority men. American Journal of Public Health, 104(2), 287–294.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mustanski, B., Garofalo, R., Herrick, A., & Donenberg, G. (2007). Psychosocial health problems increase risk for HIV among urban young men who have sex with men: Preliminary evidence of a syndemic in need of attention. Annals of Behavioral Medicine, 34(1), 37–45.

    Article  PubMed  Google Scholar 

  • Mustanski, B., Garofalo, R., Monahan, C., Gratzer, B., & Andrews, R. (2013). Feasibility, acceptability, and preliminary efficacy of an online HIV prevention program for diverse young men who have sex with men: The keep it up! intervention. AIDS and Behavior, 17(9), 2999–3012.

    Article  PubMed  Google Scholar 

  • Muthén, B., & Muthén, L. K. (2000). Integrating person centered and variable centered analyses: Growth mixture modeling with latent trajectory classes. Alcoholism, Clinical and Experimental Research, 24(6), 882–891.

    Article  PubMed  Google Scholar 

  • Muthén, L. K., & Muthén, B. O. (2017). Mplus user’s guide (Eighth ed.). Los Angeles: Author.

    Google Scholar 

  • Nagin, D. (2005). Group-based modeling of development. Cambridge, MA: Harvard University Press.

    Book  Google Scholar 

  • Newcomb, M. E. (2013). Moderating effect of age on the association between alcohol use and sexual risk in MSM: Evidence for elevated risk among younger MSM. AIDS and Behavior, 17(5), 1746–1754.

    Article  PubMed  PubMed Central  Google Scholar 

  • Newcomb, M. E., Clerkin, E. M., & Mustanski, B. (2011). Sensation seeking moderates the effects of alcohol and drug use prior to sex on sexual risk in young men who have sex with men. AIDS and Behavior, 15(3), 565–575.

    Article  PubMed  Google Scholar 

  • Newcomb, M. E., Ryan, D. T., Greene, G. J., Garofalo, R., & Mustanski, B. (2014). Prevalence and patterns of smoking, alcohol use, and illicit drug use in young men who have sex with men. Drug and Alcohol Dependence, 141, 65–71.

    Article  PubMed  PubMed Central  Google Scholar 

  • Nylund, K. L., Asparouhov, T., & Muthén, B. O. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study. Structural Equation Modeling: A Multidisciplinary Journal, 14(4), 535–569.

    Article  Google Scholar 

  • Nylund-Gibson, K., & Choi, A. (2018). Ten frequently asked questions about latent class analysis. Translational Issues in Psychological Science, 4(4), 440–461.

    Article  Google Scholar 

  • O’Donnell, S., Meyer, I. H., & Schwartz, S. (2011). Increased risk of suicide attempts among Black and Latino lesbians, gay men, and bisexuals. American Journal of Public Health, 101(6), 1055–1059.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ogunbajo, A., Oke, T., Jin, H., Rashidi, W., Iwuagwu, S., Harper, G. W., … Mimiaga, M. J. (2020). A syndemic of psychosocial health problems is associated with increased HIV sexual risk among Nigerian gay, bisexual, and other men who have sex with men (GBMSM). AIDS Care, 32(3), 337–342.

    Article  PubMed  Google Scholar 

  • Oster, A. M., Sternberg, M., Nebenzahl, S., Broz, D., Xu, F., Hariri, S., … Paz-Bailey, G. (2014). Prevalence of HIV, sexually transmitted infections, and viral hepatitis by urbanicity, among men who have sex with men, injection drug users, and heterosexuals in the United States. Sexually Transmitted Diseases, 41(4), 272–279.

    Article  PubMed  Google Scholar 

  • Pachankis, J. E., Rendina, H. J., Restar, A., Ventuneac, A., Grov, C., & Parsons, J. T. (2015). A minority stress-emotion regulation model of sexual compulsivity among highly sexually active gay and bisexual men. Health Psychology, 34(8), 829–840.

    Article  PubMed  Google Scholar 

  • Pantalone, D. W., Valentine, S. E., Woodward, E. N., & O’Cleirigh, C. (2018). Syndemic indicators predict poor medication adherence and increased healthcare utilization for urban HIV-positive men who have sex with men. Journal of Gay & Lesbian Mental Health, 22(1), 71–87.

    Article  Google Scholar 

  • Parsons, J. T., Grov, C., & Golub, S. A. (2012). Sexual compulsivity, co-occurring psychosocial health problems, and HIV risk among gay and bisexual men: Further evidence of a syndemic. American Journal of Public Health, 102(1), 156–162.

    Article  PubMed  PubMed Central  Google Scholar 

  • Parsons, J. T., Millar, B. M., Moody, R. L., Starks, T. J., Rendina, H. J., & Grov, C. (2017). Syndemic conditions and HIV transmission risk behavior among HIV-negative gay and bisexual men in a US national sample. Health Psychology, 36(7), 695–703.

    Article  PubMed  PubMed Central  Google Scholar 

  • Peate, I. (2013). The health-care needs of the older gay man living with HIV. British Journal of Community Nursing, 18(10), 492–495.

    Article  PubMed  Google Scholar 

  • Plöderl, M., Sellmeier, M., Fartacek, C., Pichler, E. M., Fartacek, R., & Kralovec, K. (2014). Explaining the suicide risk of sexual minority individuals by contrasting the minority stress model with suicide models. Archives of Sexual Behavior, 43(8), 1559–1570.

    Article  PubMed  Google Scholar 

  • Quinn, K., Voisin, D. R., Bouris, A., Jaffe, K., Kuhns, L., Eavou, R., & Schneider, J. (2017). Multiple dimensions of stigma and health related factors among young Black men who have sex with men. AIDS and Behavior, 21(1), 207–216.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rabkin, J. G., McElhiney, M. C., & Ferrando, S. J. (2004). Mood and substance use disorders in older adults with HIV/AIDS: methodological issues and preliminary evidence. AIDS, 18, 43–48.

    Article  Google Scholar 

  • Radcliffe, J., Doty, N., Hawkins, L. A., Gaskins, C. S., Beidas, R., & Rudy, B. J. (2010). Stigma and sexual health risk in HIV-positive African American young men who have sex with men. AIDS Patients Care and STDs, 24(8), 493–499.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rao, D., Kekwaletswe, T. C., Hosek, S., Martinez, J., & Rodriguez, F. (2007). Stigma and social barriers to medication adherence with urban youth living with HIV. AIDS Care, 19(1), 28–33.

    Article  PubMed  Google Scholar 

  • Reed, S. J., & Miller, R. L. (2016). Thriving and adapting: Resilience, sense of community, and syndemics among young Black gay and bisexual men. American Journal of Community Psychology, 57(1–2), 129–143.

    Article  PubMed  Google Scholar 

  • Reif, S., Safley, D., McAllaster, C., Wilson, E., & Whetten, K. (2017). State of HIV in the US Deep South. Journal of Community Health, 42, 844–853.

    Article  PubMed  Google Scholar 

  • Reinert, D. F., & Allen, J. P. (2002). The alcohol use disorders identification test (AUDIT): A review of recent research. Alcoholism, Clinical and Experimental Research, 26(2), 272–279.

    Article  PubMed  Google Scholar 

  • Rendina, H. J., Gamarel, K. E., Pachankis, J. E., Ventuneac, A., Grov, C., & Parsons, J. T. (2016). Extending the minority stress model to incorporate HIV-positive gay and bisexual men’s experiences: A longitudinal examination of mental health and sexual risk behavior. Annals of Behavioral Medicine, 51(2), 147–158.

    Article  Google Scholar 

  • Robinson, A. C., Knowlton, A. R., Gielen, A. C., & Gallo, J. J. (2016). Substance use, mental illness, and familial conflict non-negotiation among HIV-positive African-Americans: Latent class regression and a new syndemic framework. Journal of Behavioral Medicine, 39(1), 1–12.

    Article  PubMed  Google Scholar 

  • Rosario, M., Schrimshaw, E. W., & Hunter, J. (2006). A model of sexual risk behaviors among young gay and bisexual men: Longitudinal associations of mental health, substance abuse, sexual abuse, and the coming-out process. AIDS Education and Prevention, 18(5), 444–460.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rosenfeld, D., Bartlam, B., & Smith, R. D. (2012). Out of the closet and into the trenches: Gay male baby boomers, aging, and HIV/AIDS. The Gerontologist, 52(2), 255–264.

    Article  PubMed  Google Scholar 

  • Ross, L. E., Bauer, G. R., MacLeod, M. A., Robinson, M., MacKay, J., & Dobinson, C. (2014). Mental health and substance use among bisexual youth and non-youth in Ontario. Canada. PLoS One, 9(8), e101604. https://doi.org/10.1371/journal.pone.0101604

    Article  PubMed  Google Scholar 

  • Salas-Wright, C. P., Olate, R., & Vaughn, M. G. (2015). Substance use, violence, and HIV risk behavior in El Salvador and the United States: Cross-national profiles of the SAVA syndemic. Victims & Offenders, 10(1), 95–116.

    Article  Google Scholar 

  • Salter, M. L., Go, V. F., Minh, N. L., Gregowski, A., Ha, T. V., Rudolph, A., … Quan, V. M. (2010). Influence of perceived secondary stigma and family on the response to HIV infection among injection drug users in Vietnam. AIDS Education and Prevention, 22(6), 558–570.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sankar, A., Wunderlich, T., Neufeld, S., & Luborsky, M. (2007). Sero-positive African Americans’ beliefs about alcohol and their impact on anti-retroviral adherence. AIDS and Behavior, 11(2), 195–203.

    Article  PubMed  PubMed Central  Google Scholar 

  • Santos, G.-M., Do, T., Beck, J., Makofane, K., Arreola, S., Pyun, T., & Ayala, G. (2014). Syndemic conditions associated with increased HIV risk in a global sample of men who have sex with men. Sexually Transmitted Infections, 90(3), 250–253.

    Article  PubMed  Google Scholar 

  • Singer, M. (1994). AIDS and the health crisis of the US urban poor; the perspective of critical medical anthropology. Social Science and Medicine, 39(7), 931–948.

    Article  PubMed  Google Scholar 

  • Singer, M. (2000). A dose of drugs, a touch of violence, a case of AIDS: Conceptualizing the SAVA syndemic. Free Inquiry in Creative Sociology, 28(1), 13–24.

    Google Scholar 

  • Skalski, L. M., Sikkema, K. J., Heckman, T. G., & Meade, C. S. (2013). Coping styles and illicit drug use in older adults with HIV/AIDS. Psychology of Addictive Behaviors, 27(4), 1050–1058.

    Article  PubMed  Google Scholar 

  • Smith, G. W., Farrell, M., Bunting, B. P., Houston, J. E., & Shevlin, M. (2011). Patterns of polydrug use in Great Britain: Findings from a national household population survey. Drug and Alcohol Dependence, 113(2–3), 222–228.

    Article  PubMed  Google Scholar 

  • Smith, M. K., Stein, G., Cheng, W., Miller, W. C., & Tucker, J. D. (2019). Identifying high risk subgroups of MSM: A latent class analysis using two samples. BMC Infectious Diseases, 19(1), 213. https://doi.org/10.1186/s12879-019-3700-5.

    Article  PubMed  Google Scholar 

  • Stall, R., Friedman, M., & Catania, J. (2008). Interacting epidemics and gay men's health: A theory of syndemic production among urban gay men. In R. J. Wolitski, R. Stall., & R. O Valdiserri (Eds.), Unequal opportunity: Health disparities affecting gay and bisexual men in the United States (pp 252–274). Oxford University Press.

  • Stall, R., Mills, T. C., Williamson, J., Hart, T., Greenwood, G., Paul, J., & Catania, J. A. (2003). Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. American Journal of Public Health, 93(6), 939–942.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stall, R., Paul, J. P., Greenwood, G., Pollack, L. M., Bein, E., Crosby, G. M., & Catania, J. A. (2001). Alcohol use, drug use and alcohol-related problems among men who have sex with men: The Urban Men’s Health Study. Addiction, 96(11), 1589–1601.

    Article  PubMed  Google Scholar 

  • Stall, R., & Purcell, D. W. (2000). Intertwining epidemics: A review of research on substance use among men who have sex with men and its connection to the AIDS epidemic. AIDS and Behavior, 4(2), 181–192.

    Article  Google Scholar 

  • Starks, T. J., Millar, B. M., Eggleston, J. J., & Parsons, J. T. (2014). Syndemic factors associated with HIV risk for gay and bisexual men: Comparing latent class and latent factor modeling. AIDS and Behavior, 18(11), 2075–2079.

    Article  PubMed  Google Scholar 

  • Talley, A. E., Hughes, T. L., Aranda, F., Birkett, M., & Marshal, M. P. (2014). Exploring alcohol-use behaviors among heterosexual and sexual minority adolescents: intersections with sex, age, and race/ethnicity. American Journal of Public Health, 104(2), 295–303.

    Article  PubMed  PubMed Central  Google Scholar 

  • Tan, D. H., Leon-Carlyle, M., Mills, R., Moses, E., & Carvalhal, A. (2016). Self-administered screening for syndemic mental health problems should be routinely implemented among MSM PrEP users. Journal of Gay & Lesbian Mental Health, 20(1), 13–20.

    Article  Google Scholar 

  • Thiede, H., Valleroy, L. A., MacKellar, D. A., Celentano, D. D., Ford, W. L., Hagan, H., … Torian, L. V. (2003). Regional patterns and correlates of substance use among young men who have sex with men in 7 US urban areas. American Journal of Public Health, 93(11), 1915–1921.

    Article  PubMed  PubMed Central  Google Scholar 

  • Tomori, C., McFall, A. M., Solomon, S. S., Srikrishnan, A. K., Anand, S., Balakrishnan, P., & Celentano, D. D. (2018). Is there synergy in syndemics? Psychosocial conditions and sexual risk among men who have sex with men in India. Social Science and Medicine, 206, 110–116.

    Article  PubMed  Google Scholar 

  • Tsai, A. C., & Burns, B. F. (2015). Syndemics of psychosocial problems and HIV risk: A systematic review of empirical tests of the disease interaction concept. Social Science and Medicine, 139, 26–35.

    Article  PubMed  Google Scholar 

  • Tsai, A. C., & Venkataramani, A. S. (2016). Syndemics and health disparities: A methodological note. AIDS and Behavior, 20(2), 423–430.

    Article  PubMed  PubMed Central  Google Scholar 

  • Vanable, P. A., McKirnan, D. J., Buchbinder, S. P., Bartholow, B. N., Douglas, J. M., Judson, F. N., & MacQueen, K. M. (2004). Alcohol use and high-risk sexual behavior among men who have sex with men: the effects of consumption level and partner type. Health Psychology, 23(5), 525–532.

    Article  PubMed  Google Scholar 

  • Vermunt, J. K., & Magidson, J. (2016). Technical guide for latent gold 5.1: Basic, advanced, and syntax. Belmont, MA: Statistical Innovations.

  • Vincent, W., Peterson, J. L., Storholm, E. D., Huebner, D. M., Neilands, T. B., Calabrese, S. K., … Kegeles, S. M. (2019). A person-centered approach to HIV-related protective and risk factors for young black men who have sex with men: Implications for pre-exposure prophylaxis and HIV treatment as prevention. AIDS and Behavior, 23(10), 2803–2815.

    Article  PubMed  PubMed Central  Google Scholar 

  • Weatherburn, P., Davies, P. M., Hickson, F. C. I., Hunt, A. J., McManus, T. J., & Coxon, A. P. M. (1993). No connection between alcohol use and unsafe sex among gay and bisexual men. AIDS, 7, 115–119.

    Article  PubMed  Google Scholar 

  • Wilson, P. A., Nanin, J., Amesty, S., Wallace, S., Cherenack, E. M., & Fullilove, R. (2014). Using syndemic theory to understand vulnerability to HIV infection among Black and Latino men in New York City. Journal of Urban Health, 91(5), 983–998.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wolitski, R. J., Stall, R., & Valdiserri, R. O. (Eds.). (2008). Unequal opportunity: Health disparities affecting gay and bisexual men in the United States. Oxford, England: Oxford University Press.

    Google Scholar 

  • Zarwell, M., Ransome, Y., Barak, N., Gruber, D., & Robinson, W. T. (2019). PrEP indicators, social capital and social group memberships among gay, bisexual and other men who have sex with men. Culture, Health & Sexuality, 21(12), 1349–1366.

    Article  Google Scholar 

Download references

Acknowledgements

Jillian Scheer’s and Anthony Maiolatesi’s manuscript preparation time was supported by the Yale Center for Interdisciplinary Research on AIDS training program (T32MH020031; PI: Kershaw).

Author information

Authors and Affiliations

  1. Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY, 13244, USA

    Jillian R. Scheer

  2. Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA

    Kirsty A. Clark, Anthony J. Maiolatesi & John E. Pachankis

  3. Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA

    Anthony J. Maiolatesi & John E. Pachankis

Authors
  1. Jillian R. Scheer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kirsty A. Clark
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anthony J. Maiolatesi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John E. Pachankis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jillian R. Scheer.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Human and Animal Rights

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

We obtained informed consent from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Scheer, J.R., Clark, K.A., Maiolatesi, A.J. et al. Syndemic Profiles and Sexual Minority Men’s HIV-Risk Behavior: A Latent Class Analysis. Arch Sex Behav 50, 2825–2841 (2021). https://doi.org/10.1007/s10508-020-01850-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-020-01850-4

Keywords

Search

Navigation