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Examining a Syndemics Network Among Young Latino Men Who Have Sex with Men

International Journal of Behavioral Medicine volume 27, pages 39–51 (2020)Cite this article

Abstract

Background

Although studies consistently find that syndemic indicators are additively associated with increased HIV/STI risk behavior (e.g., condomless anal sex; CAS) among men who have sex with men (MSM), information is lacking about how syndemic indicators are associated with each other. Young Latino MSM are one of the most at-risk groups for acquiring HIV in the U.S. Understanding the associations of syndemic indicators with each other and with CAS may improve understanding of how to enhance sexual and behavioral health in this population.

Method

Network analysis using the graphical LASSO (glasso) algorithm was employed to explore associations between CAS and syndemic indicators among 139 young Latino MSM. Structural and psychosocial syndemic indicators were assessed via self-report. CAS was defined as the number of partners in the past 3 months with whom one engaged in CAS.

Results

Results of the network analysis suggested the variables with the highest centrality were unstable housing, prison history, childhood sexual abuse, and CAS. Specific significant associations included links between CAS and alcohol use (b = 0.40), childhood sexual abuse and unstable housing (b = − 0.75), alcohol use and childhood sexual abuse (b = 0.40), and substance use and intimate partner violence (b = 0.43).

Conclusion

This pattern of interconnectedness demonstrates the potential for network analysis to examine nuanced interrelationships of syndemic indicators. The specific associations in this sample raise the question whether a primary focus of interventions should address the more central syndemic indicators for this population, such as alcohol use and unstable housing, and whether this would, via downstream effects, affect other aspects of behavioral health in this population.

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References

  1. Singer M. AIDS and the health crisis of the U.S. urban poor; the perspective of critical medical anthropology. Soc Sci Med. 1994;39:931–48.

    CAS  PubMed  Google Scholar 

  2. Ferlatte O, Hottes TS, Trussler T, Marchand R. Evidence of a syndemic among young Canadian gay and bisexual men: uncovering the associations between anti-gay experiences, psychosocial issues, and HIV risk. AIDS Behav. 2014;18:1256–63.

    PubMed  Google Scholar 

  3. Martinez O, Arreola S, Wu E, Muñoz-Laboy M, Levine E, Rutledge SE, et al. Syndemic factors associated with adult sexual HIV risk behaviors in a sample of Latino men who have sex with men in New York City. Drug Alcohol Depend. 2016;166:258–62.

    PubMed  PubMed Central  Google Scholar 

  4. Mimiaga MJ, Biello KB, Robertson AM, Oldenburg CE, Rosenberger JG, O’Cleirigh C, et al. High prevalence of multiple syndemic conditions associated with sexual risk behavior and HIV infection among a large sample of Spanish- and Portuguese-speaking men who have sex with men in Latin America. Arch Sex Behav. 2015;44:1869–78.

    PubMed  Google Scholar 

  5. Mustanski B, Garofalo R, Herrick A, Donenberg G. 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. Ann Behav Med. 2007;34:37–45.

    PubMed  PubMed Central  Google Scholar 

  6. Parsons JT, Grov C, Golub SA. Sexual compulsivity, co-occurring psychosocial health problems, and HIV risk among gay and bisexual men: further evidence of a syndemic. Am J Public Health. 2012;102:156–62.

    PubMed  PubMed Central  Google Scholar 

  7. Stall R, Mills TC, Williamson J, Hart T, Greenwood G, Paul J, et al. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. Am J Public Health. 2003;93:939–42.

    PubMed  PubMed Central  Google Scholar 

  8. O’Cleirigh C, Pantalone DW, Batchelder AW, Hatzenbuehler ML, Marquez SM, Grasso C, et al. Co-occurring psychosocial problems predict HIV status and increased health care costs and utilization among sexual minority men. J Behav Med. 2018:1–8.

  9. Bränström R, Pachankis JE. Validating the syndemic threat surrounding sexual minority men’s health in a population-based study with National Registry Linkage and a heterosexual comparison. JAIDS J Acquir Immune Defic Syndr. 2018;1.

  10. Guadamuz TE, McCarthy K, Wimonsate W, Thienkrua W, Varangrat A, Chaikummao S, et al. 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. AIDS Behav. 2014;18:2089–96.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Mimiaga MJ, O’Cleirigh C, Biello KB, Robertson AM, Safren SA, Coates TJ, et al. 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. JAIDS J Acquir Immune Defic Syndr. 2015;68:329–36.

    PubMed  Google Scholar 

  12. Mustanski B, Phillips G, Ryan DT, Swann G, Kuhns L, Garofalo R. Prospective effects of a syndemic on HIV and STI incidence and risk behaviors in a cohort of young men who have sex with men. AIDS Behav. 2017;21:845–57.

    PubMed  PubMed Central  Google Scholar 

  13. Tsai AC, Burns BFO. Syndemics of psychosocial problems and HIV risk: a systematic review of empirical tests of the disease interaction concept. Soc Sci Med. 2015;139:26–35.

    PubMed  PubMed Central  Google Scholar 

  14. Tsai AC, Venkataramani AS. Syndemics and health disparities: a methodological note. AIDS Behav. 2016;20:423–30.

    PubMed  PubMed Central  Google Scholar 

  15. Tsai AC. Syndemics: a theory in search of data or data in search of a theory? Soc Sci Med. 2018;206:117–22.

    PubMed  PubMed Central  Google Scholar 

  16. Starks TJ, Millar BM, Eggleston JJ, Parsons JT. Syndemic factors associated with HIV risk for gay and bisexual men: comparing latent class and latent factor modeling. AIDS Behav. 2014;18:2075–9.

    PubMed  Google Scholar 

  17. Scott J. Social network analysis. 2nd ed. SAGE: Los Angeles, CA; 2017.

    Google Scholar 

  18. Santos H, Fried EI, Asafu-Adjei J, Ruiz RJ. Network structure of perinatal depressive symptoms in Latinas: relationship to stress and reproductive biomarkers. Res Nurs Health. 2017;40:218–28.

    PubMed  PubMed Central  Google Scholar 

  19. Choi KW, Batchelder AW, Ehlinger PP, Safren SA, O’Cleirigh C. Applying network analysis to psychological comorbidity and health behavior: depression, PTSD, and sexual risk in sexual minority men with trauma histories. J Consult Clin Psychol. 2017;85:1158.

    PubMed  PubMed Central  Google Scholar 

  20. Cramer AOJ, Waldorp LJ, van der Maas HLJ, Borsboom D. Comorbidity: a network perspective. Behav Brain Sci. 2010;33:137–93.

    PubMed  Google Scholar 

  21. Epskamp S, Fried EI. A tutorial on regularized partial correlation networks. Psychol Methods. 2018;

  22. Rhemtulla M, Fried EI, Aggen SH, Tuerlinckx F, Kendler KS, Borsboom D. Network analysis of substance abuse and dependence symptoms. Drug Alcohol Depend. 2016;161:230–7.

    PubMed  PubMed Central  Google Scholar 

  23. Armour C, Fried EI, Deserno MK, Tsai J, Pietrzak RH. A network analysis of DSM-5 posttraumatic stress disorder symptoms and correlates in U.S. military veterans. J Anxiety Disord. 2017;45:49–59.

    PubMed  Google Scholar 

  24. Borsboom D, Cramer AO. Network analysis: an integrative approach to the structure of psychopathology. Annu Rev Clin Psychol. 2013;9:91–121.

    PubMed  Google Scholar 

  25. Centers for Disease Control and Prevention. HIV and Hispanic/Latino Gay and Bisexual Men [Internet]. HIV. 2019 [cited 2019 Sep 8]. Available from: https://www.cdc.gov/hiv/group/msm/hispanic-latino.html

  26. Centers for Disease Control and Prevention. HIV and Gay and Bisexual Men [Internet]. HIV. 2019 [cited 2019 Sep 8]. Available from: https://www.cdc.gov/hiv/group/msm/index.html

  27. Blashill AJ, Brady JP, Rooney BM, Rodriguez-Diaz CE, Horvath KJ, Blumenthal J, et al. Syndemics and the PrEP Cascade: Results from a Sample of Young Latino Men Who Have Sex with Men. Arch Sex Behav [Internet]. 2019 [cited 2019 Oct 14]; Available from: https://doi.org/10.1007/s10508-019-01470-7

  28. Kroenke K, Strine TW, Spitzer RL, Williams JBW, Berry JT, Mokdad AH. The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2009;114:163–73.

    PubMed  Google Scholar 

  29. Sherin KM, Sinacore JM, Li X-Q, Zitter RE, Shakil A. HITS: a short domestic violence screening tool for use in a family practice setting. Fam Med. 1998;30:508–12.

    CAS  PubMed  Google Scholar 

  30. Shakil A, Donald S, Sinacore JM, Krepcho M. Validation of the HITS domestic violence screening tool with males. Fam Med. 2005;37:193–8.

    PubMed  Google Scholar 

  31. Finkelhor D. Current information on the scope and nature of child sexual abuse. Futur Child. 1994;4:31–53.

    CAS  Google Scholar 

  32. Marin G, Gamba RJ. A new measurement of acculturation for Hispanics: the Bidimensional acculturation scale for Hispanics (BAS). Hisp J Behav Sci. 1996;18:297–316.

    Google Scholar 

  33. R Development Core team. R: a language and environment for statistical computing [internet]. Vienna, Austria: R Foundation for statistical Computing; 2016. Available from: http://www.R-project.org

  34. Epskamp S, Costantini G, Haslbeck J, Cramer AOJ, Waldorp LJ, Borsboom VDS and D. qgraph: Graph Plotting Methods, Psychometric Data Visualization and Graphical Model Estimation [Internet]. 2017. Available from: https://CRAN.R-project.org/package=qgraph

  35. Haslbeck J. mgm: estimating time-varying k-order mixed graphical models [Internet]. 2017. Available from: https://CRAN.R-project.org/package=mgm

  36. Epskamp S, Fried EI. bootnet: bootstrap methods for various network estimation routines [Internet]. 2017. Available from: https://CRAN.R-project.org/package=bootnet

  37. Borkulo CD van, Epskamp S, Robitzsch A. IsingFit: fitting Ising models using the ELasso method [internet]. 2016. Available from: https://CRAN.R-project.org/package=IsingFit

  38. Fox J. polycor: polychoric and polyserial correlations [Internet]. 2016. Available from: https://CRAN.R-project.org/package=polycor

  39. Holgado-Tello FP, Chacón-Moscoso S, Barbero-García I, Vila-Abad E. Polychoric versus Pearson correlations in exploratory and confirmatory factor analysis of ordinal variables. Qual Quant. 2010;44:153.

    Google Scholar 

  40. Mazumder R, Hastie T. The graphical lasso: new insights and alternatives. Electron J Stat. 2012;6:2125–49.

    PubMed  PubMed Central  Google Scholar 

  41. Boccaletti S, Latora V, Moreno Y, Chavez M, Hwang D-U. Complex networks: structure and dynamics. Phys Rep. 2006;424:175–308.

    Google Scholar 

  42. Opsahl T, Agneessens F, Skvoretz J. Node centrality in weighted networks: generalizing degree and shortest paths. Soc Networks. 2010;32:245–51.

    Google Scholar 

  43. Fried EI, Haslbeck J. Depression and (no) inflammation? Using network analysis to examine links between individual depressive symptoms and inflammatory markers. PsyArXiv [Internet]. 2018 [cited 2018 Jul 25]; Available from: https://psyarxiv.com/84ske/

  44. Vosburgh HW, Mansergh G, Sullivan PS, Purcell DW. A review of the literature on event-level substance use and sexual risk behavior among men who have sex with men. AIDS Behav. 2012;16:1394–410.

    PubMed  Google Scholar 

  45. Koblin BA, Chesney MA, Husnik MJ, Bozeman S, Celum CL, Buchbinder S, Mayer K, McKirnan D, Judson FN, Huang Y, Coates TJ, EXPLORE Study Team. High-risk behaviors among men who have sex with men in 6 US cities: baseline data from the EXPLORE study. Am J Public Health 2003;93:926–932.

  46. Berg RC. Barebacking among MSM internet users. AIDS Behav. 2008;12:822–33.

    PubMed  Google Scholar 

  47. Mustanski B. Moderating effects of age on the alcohol and sexual risk taking association: an online daily diary study of men who have sex with men. AIDS Behav. 2008;12:118–26.

    PubMed  Google Scholar 

  48. Balán IC, Carballo-Diéguez A, Ventuneac A, Remien RH. Intentional condomless anal intercourse among Latino MSM who meet sexual partners on the Internet. AIDS Educ Prev. 2009;21:14–24.

    PubMed  PubMed Central  Google Scholar 

  49. Kahler CW, Pantalone DW, Mastroleo NR, Liu T, Bove G, Ramratnam B, et al. Motivational interviewing with personalized feedback to reduce alcohol use in HIV-infected men who have sex with men: a randomized controlled trial. J Consult Clin Psychol. 2018;86:645–56.

    PubMed  PubMed Central  Google Scholar 

  50. Velasquez MM, von Sternberg K, Johnson DH, Carbonari JP, Green C, Parsons JT. Reducing sexual risk behaviors and alcohol use among HIV-positive men who have sex with men: a randomized clinical trial. J Consult Clin Psychol. 2009;77:657–67.

    PubMed  PubMed Central  Google Scholar 

  51. Lloyd S, Operario D. HIV risk among men who have sex with men who have experienced childhood sexual abuse: systematic review and meta-analysis. AIDS Educ Prev. 2012;24:228–41.

    PubMed  Google Scholar 

  52. Lee W, Ti L, Marshall BDL, Dong H, Wood E, Kerr T. Childhood sexual abuse and syringe sharing among people who inject drugs. AIDS Behav. 2015;19:1415–22.

    PubMed  PubMed Central  Google Scholar 

  53. Arreola SG, Neilands TB, Pollack LM, Paul JP, Catania JA. Higher prevalence of childhood sexual abuse among Latino men who have sex with men than non-Latino men who have sex with men: data from the urban men’s health study. Child Abuse Negl. 2005;29:285–90.

    PubMed  Google Scholar 

  54. Patterson TL. Methamphetamine-using HIV-positive men who have sex with men: correlates of polydrug use. J Urban Health Bull N Y Acad Med. 2005;82:i120–6.

    Google Scholar 

  55. Lee SJ, Galanter M, Dermatis H, McDowell D. Circuit parties and patterns of drug use in a subset of gay men. J Addict Dis. 2004;22:47–60.

    Google Scholar 

  56. Traeger MW, Schroeder SE, Wright EJ, Hellard ME, Cornelisse VJ, Doyle JS, et al. Effects of pre-exposure prophylaxis for the prevention of human immunodeficiency virus infection on sexual risk behavior in men who have sex with men: a systematic review and meta-analysis. Clin Infect Dis [Internet]. 2018 [cited 2018 Apr 22]; Available from: https://doi.org/10.1093/cid/ciy182/4917600

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Acknowledgements

Funding for this project came from the Department of Psychology at San Diego State University. Some of the author time was supported by 9K24DA040489 (Safren) and 7K23MH096647 (Blashill). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health, or any of the other funders.

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Affiliations

  1. Department of Psychology, University of Miami, Coral Gables, FL, USA

    Jasper S. Lee, Steven A. Safren & Sierra A. Bainter

  2. Milken Institute School of Public Health, The George Washington University, Washington, D.C, USA

    Carlos E. Rodríguez-Díaz

  3. Department of Psychology, San Diego State University, 6363 Alvarado Court, Suite 101, San Diego, CA, 92120, USA

    Keith J. Horvath & Aaron J. Blashill

  4. San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA

    Keith J. Horvath & Aaron J. Blashill

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  1. Jasper S. Lee
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Correspondence to Aaron J. Blashill.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (San Diego State University Institutional Review Board + reference number HS-2017-0006) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Lee, J.S., Safren, S.A., Bainter, S.A. et al. Examining a Syndemics Network Among Young Latino Men Who Have Sex with Men. Int.J. Behav. Med. 27, 39–51 (2020). https://doi.org/10.1007/s12529-019-09831-1

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Keywords

  • Network analysis
  • HIV
  • Syndemic indicators
  • Men who have sex with men
  • Latino