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Syndemic Vulnerability and Condomless Sex Among Incarcerated Men in Mexico City: A Latent Class Analysis

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Abstract

In order to address common statistical and population-based limitations in epidemiological literature applying syndemic theory, this study uses latent class analysis (LCA) to explore how health and social problems coalesce and shape sexual risk behaviors linked to HIV transmission in three Mexico City prisons. Among the studied male inmates, LCA identified four classes, defined by low syndemic risk (61.4%); marijuana (14.3%); depression, substances, and trauma (19.7%); and depression, substances, and marijuana (4.7%). In multinomial regression models, classes with a greater number of syndemic exposures were associated with increased odds of condomless anal sex during incarceration. In analyses stratified by pre-incarceration sexual risk behaviors, however, high syndemic burden classes were associated with condomless anal sex during incarceration differently. Overall, the study findings suggest that LCA has potential utility for syndemic analyses and highlight the need to attend to health and social adversities when addressing sexual risk behaviors and HIV transmission during incarceration.

Resumen

En este estudio exploramos cómo los problemas sociales y de salud se juntan y determinan la formación de comportamientos de riesgo para la transmisión del VIH en tres prisiones de la Ciudad de México. Usamos análisis de clases latentes (ACL) para abordar limitaciones estadísticas y poblacionales comunes en la literatura epidemiológica que aplica la teoría de la sindemia. Entre la población estudiada de hombres internos adultos, identificamos cuatro clases, definidas por bajo riesgo sindémico (61.4%); uso de mariguana (14.3%); depresión, uso de sustancias y victimización traumática (19.7%); y depresión, uso de sustancias y de mariguana (4.7%). De acuerdo a los resultados de modelos de regresión multinomial, las clases con un mayor número de exposiciones sindémicas se asociaron con mayor posibilidad de sexo anal sin condón durante la encarcelación. En análisis estratificados de acuerdo a la presencia de comportamientos sexuales de riesgo pre-encarcelación, las clases con una carga de alta sindemia se asociaron con sexo anal sin condón de manera diferente. Los resultados del estudio sugieren que el ACL tiene utilidad potencial para el análisis sindémico y resaltan la necesidad de atender adversidades sociales y de salud cuando se abordan los comportamientos sexuales de riesgo durante la encarcelación.

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Acknowledgements

The authors gratefully acknowledge staff of the Penitentiary System in Mexico City, including Celina Oceguera and Clementina Rodriguez whose vision allowed this project to be possible. The authors appreciate the support of everyone who participated in the conception and implementation of the Ponte a Prueba campaign, which enabled data collection for this study. Dr. Andrea Gonzalez and Nathalie Gras Allain from the HIV/AIDS Program in Mexico City particularly were instrumental in the development, implementation, and supervision of Ponte a Prueba. We also acknowledge the work of the Surveys Division at the National Institute of Public Health (INSP), including the leadership of Aurora Franco. Above all, we appreciate the inmates at the Reclusorios Ceresova, Norte, and Sur.

Funding

This work was supported by the Ministry of Health of Mexico City under Contract INSP-2010-340.

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Authors and Affiliations

  1. Psychiatric Consultation-Liaison Service, Legacy Health, Portland, OR, USA

    Christine Bourey

  2. Department of Health Behavior and Biological Sciences, School of Nursing and Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA

    Rob Stephenson

  3. Division of Health Economics and Health Systems Innovations, Center for Health Systems Research, National Institute of Public Health (INSP), Cuernavaca, Mexico

    Sergio Bautista-Arredondo

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Bourey, C., Stephenson, R. & Bautista-Arredondo, S. Syndemic Vulnerability and Condomless Sex Among Incarcerated Men in Mexico City: A Latent Class Analysis. AIDS Behav 22, 4019–4033 (2018). https://doi.org/10.1007/s10461-018-2216-0

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