Syndemic of Substance Abuse, Depression, and Type 2 Diabetes and Their Association with Retention in Care Among People Living with HIV.

Substance abuse (SA), depression, and type 2 diabetes (DM2) often co-occur among people living with HIV (PLHIV). Guided by a syndemic framework, this cross-sectional retrospective study examined the cumulative and interaction effects of SA, depression, and DM2 on retention in HIV care (RIC) among 621 PLHIV receiving medical care in central Pennsylvania. We performed logistic regression analysis to test the associations between SA, depression, and DM2 and RIC. To test the "syndemic" model, we assessed additive and multiplicative interactions. In an unadjusted model, a dose-response pattern between the syndemic index (total number of health conditions) and RIC was detected (OR for 1 syndemic factor vs. none: 1.01, 95% CI: 0.69-1.47; 2 syndemic factors: 1.59, 0.89-2.84; 3 syndemic factors: 1.62, 0.44-5.94), but no group reached statistical significance. Interactions on both additive and multiplicative scales were not significant, demonstrating no syndemic effect of SA, depression, and DM2 on RIC among our study sample. Our findings highlight that comorbid conditions may, in some populations, facilitate RIC rather than act as barriers, which may be due to higher levels of engagement with medical care.

Drug use during the second year of the COVID-19 pandemic: observations from repeated cross-sectional surveys of sexual minority men in the US active on social networking applications.

Studies conducted early in the COVID-19 pandemic - before vaccines were widely available - indicated that drug use may have declined among sexual minority men (SMM). This study evaluated drug use trends in the second year of the pandemic. Cross-sectional responses from cisgender SMM living in the US and recruited online (n = 15,897) were grouped for analyses: Time 1: 3/1/2021-5/30/2021; Time 2: 6/1/2021-8/31/2021; Time 3: 9/1/2021-11/30/2021; and Time 4: 12/1 2021-2/28/2022. Results of multivariable models indicated that illicit drug use (excluding cannabis) increased at Times 2 (OR = 1.249, p < .001), 3 (OR = 1.668, p < .001), and 4 (OR = 1.674, p < .001) compared to Time 1. In contrast, cannabis use was relatively stable over time. Rates did not differ significantly among Times 1, 2, and 4. While rates of COVID-19 vaccination increased over time, illicit drug use was negatively associated with the odds of vaccination (OR = 0.361, p < .001). These findings highlight the need for ongoing attention to the risks drug use poses among SMM. Illicit drug use - a long-standing health disparity among SMM - increased significantly across the second year of the pandemic. Because they are less likely to be vaccinated, SMM who use illicit drugs may be at greater risk of COVID-19 infection or complications.

Testing a syndemics perspective on the effects of multiple adversities on depression and anxiety symptoms in a representative population sample.

PURPOSE: Considerable empirical evidence indicates that stressful life experiences may have a negative impact on mental health. However, it is unclear how multiple adverse experiences may intersect to influence symptoms of depression and anxiety. Using a syndemics approach to identify potential synergistic effects between major stressors, we aimed to quantify the roles of multiple recent adverse life experiences on depression and anxiety symptoms. METHODS: A population-representative sample of 1090 Australian adults (53% women, Mage 47 years) completed a cross-sectional survey in 2022 that assessed mental health and retrospective reports of nine specific stressful life experiences in the past year. RESULTS: The most common adverse life experiences in the past year were financial problems (64%), loneliness (63%), or a major health problem (51%). In multivariate logistic regression analyses, financial problems, personal health problems, health problems in a close contact, relationship problems and loneliness were significantly associated with both depression and anxiety symptoms (p < 0.05). There was just one synergistic interaction and one buffering interaction of combined adversities on anxiety, and no synergistic interactions of adverse experiences on depression. The perceived impact of combined adversities was associated with both depression (b = 0.59, p < 0.001) and anxiety (b = 0.48, p < 0.001). CONCLUSION: Adversity was strongly associated with depression and anxiety. Inconsistent with a syndemics framework, there were very few synergistic relationships between different types of adversities, suggesting that different adverse experiences may independently influence mental health. The findings indicate important opportunities for early intervention to prevent depression and anxiety during difficult times.

Drowning in the ripple effect: identifying a syndemic network of health experience (with modifiable health behaviours) using the UK Biobank.

A Syndemic model of health experience in severe mental illness (SMI) involving modifiable health behaviour contributors has been theorised but has not yet been investigated. Over the next 10 years mental ill-health and suicidal behaviours have been predicted to increase which will decrease health experience and increase hospitalisation and associated costs. This paper investigated a Syndemic model of health experience in people with SMI informed by physical activity levels, exposure to nature, personal resilience levels, drugs related (tobacco smoking and alcohol consumption), and sleep behaviours using UK Biobank data. Results implementing SEM indicate partial evidence for a Syndemic model, with personal resilience being at its centre. Contrary to previous findings, drugs related behaviours did not play an important role in the model. Implementing a Syndemic framework approach to current health care strategies could be beneficial in the development of self-management strategies for people with SMI. This is the first paper using SEM analyses to investigate SMI under the Syndemic theory paradigm.

Trust Building in Public Health Approaches: The Importance of a "People-Centered" Concept in Crisis Response.

Purpose: To argue for trust-building as a key solution for responding to public health crises in the face of political ambiguity in international health governance. Patients and Methods: This perspective piece reviews fundamental concepts and discusses future directions using secondary data from open-access sources. Results: The promise of learning from Covid-19 and previous public health crises, along with the growing recognition of a 'Health For All Policies' approach, clash with siloed preparations, management, and recovery plans for future emergency crises. Trust is proposed as a possible solution to overcome these limitations. It acts as a binding force that unites individuals within the community, fostering a sense of belonging and participation. Trust-building is viewed as a "People-Centered" approach in Crisis Response, aimed at creating active and resilient communities to foster preparation and readiness, respond to emergent risks, facilitate recovery, and mitigate risks. A remaining question is how to measure and identify the dimensions and determinants of trust in specific circumstances. Some ideas are systematized to highlight the pathway to build trust in public health approaches, including transparency, education, robust and equitable health systems, strengthened social capital, stakeholders' engagement, and health workforce training. Conclusion: Trust in public health approaches can be fostered through consistent delivery of quality care, a clear, shared vision, and values underpinned by ethical standards. It requires a commitment to stakeholder well-being, including staff, and the integration of reliability, integrity, and transparency into policies, strategies, and practices. Exemplary leadership, openness in resource utilization, addressing waste or corruption, and effective communication of these principles are essential.

Smartphone and Wearable Device-Based Digital Phenotyping to Understand Substance use and its Syndemics.

Digital phenotyping is a process that allows researchers to leverage smartphone and wearable data to explore how technology use relates to behavioral health outcomes. In this Research Concepts article, we provide background on prior research that has employed digital phenotyping; the fundamentals of how digital phenotyping works, using examples from participant data; the application of digital phenotyping in the context of substance use and its syndemics; and the ethical, legal and social implications of digital phenotyping. We discuss applications for digital phenotyping in medical toxicology, as well as potential uses for digital phenotyping in future research. We also highlight the importance of obtaining ground truth annotation in order to identify and establish digital phenotypes of key behaviors of interest. Finally, there are many potential roles for medical toxicologists to leverage digital phenotyping both in research and in the future as a clinical tool to better understand the contextual features associated with drug poisoning and overdose. This article demonstrates how medical toxicologists and researchers can progress through phases of a research trajectory using digital phenotyping to better understand behavior and its association with smartphone usage.

A historical syndemic? The impact of synergistic epidemics of measles and scarlet fever on life expectancy in Victoria, Australia (1860s-1870s).

OBJECTIVES: To explore whether synergistic epidemics of measles and scarlet fever in 1860s-1870s Victoria, Australia could be characterized as syndemics, we apply the methods of Sawchuk, Tripp, and Samakaroon (Social Science & Medicine 2022, 295, 112956) to quantify the impact of each of the two major co-occurring epidemic events (1867, 1875) in terms of life expectancy (LE) changes. Sawchuk et al. posit the presence of a harvesting effect, indicated by a statistically significant increase in LE in the immediate post-epidemic "fallow period", as a criterion for identification of a historical syndemic. We test an alternate hypothesis that the same methods can identify a short-term scarring effect. MATERIALS AND METHODS: Using annual age- and cause-specific death statistics and census population data, we constructed abridged period life tables for baseline period, potential syndemic year, and "fallow" year for each of the two periods (1860s and 1870s). We compared LE at birth using Z-tests. We decomposed age-cause-specific mortality according to Arriaga's method to identify age-and cause-specific contributions to LE change. RESULTS: LE was significantly lower than baseline (1864-1865) in 1867 but not in the "fallow" year (1869). LE in 1875 and the 1878 "fallow" year were both significantly below baseline (1871-1873). Age-cause-specific decomposition showed similar patterns for 1867 and 1875 for measles and scarlet fever combined effects. DISCUSSION: Evidence of a scarring effect following the 1875 measles/scarlet fever combined peak supports the interpretation of this event as a syndemic. We suggest the short-term scarring effect can be a useful additional criterion for identifying historical syndemics.

Conceptualizing COVID-19 syndemics: A scoping review.

Background: COVID-19's heavy toll on human health, and its concentration within specific at-risk groups including the socially vulnerable and individuals with comorbidities, has made it the focus of much syndemic discourse. Syndemic theory recognizes that social factors create the conditions that support the clustering of diseases and that these diseases interact in a manner that worsens health outcomes. Syndemics theory has helped to facilitate systems-level approaches to disease as a biosocial phenomenon and guide prevention and treatment efforts. Despite its recognized value, reviews of syndemics literature have noted frequent misuse of the concept limiting its potential in guiding appropriate interventions. Objective: To review how the term 'syndemic' is defined and applied within peer-reviewed literature in relation to COVID-19. Design: A scoping review of definitions within COVID-19 literature published between January 1, 2020 to May 15, 2023 was conducted. Searches took place across six databases: Academic Search Premier, CINAHL, JSTOR, MEDLINE/Pubmed, PsycINFO and Scopus. PRISMA-ScR guidelines were followed. Results: Content analysis revealed that COVID-19 has varied clustered configurations of communicable-non-communicable diseases and novel communicable disease interactions. Spatial analysis was presented as a new strategy to evidence syndemic arrangements. However, syndemics continue to be regarded as universal, with continued misunderstanding and misapplication of the concept. Conclusion: This review found that current applications of syndemics remain problematic. Recommendations are made on the design of syndemic studies. A syndemic framework offers an opportunity for systems-level thinking that considers the full complexity of human-disease interactions and is useful to inform future pandemic preparations and responses.

The impact of syndemic burden, age, and sexual minority status on internalized HIV stigma among people living with HIV in South Florida.

Internalized HIV stigma has been associated with several poor mental and physical health outcomes among people living with HIV (PLWH); yet, little research has explored how internalized HIV stigma may be affected by syndemic burden. This study sought to examine the relationship between syndemic conditions and HIV stigma over and above the potential effects of two social determinants of health, age and sexual minority status, using a linear regression approach (N = 1343). Syndemic burden was significantly positively associated with internalized HIV stigma above and beyond the effects of age and sexual minority status (b = 0.23). Additionally, age (b = -0.02) and being a sexually minority (b = -0.31) were significantly negatively associated with internalized HIV stigma. Findings should inform future treatment targets for this population by specifically working to reduce internalized HIV stigma for people with a greater syndemic burden and, potentially, among young adults and heterosexual PLWH.

The Intersection of Mental Health and Sexual and Gender Minority Identities for Older Adults Living with Human Immunodeficiency Virus: A Narrative Review.

The transition of HIV into a chronic illness has brought to the forefront the pressing need to address the complex web of social determinants of HIV outcomes. A structured literature search and narrative review of studies describing intervention strategies for mental health among sexual/gender minority (SGM) older adults living with HIV (OALWH) published in the last decade identified 2 studies for inclusion. This narrative review identifies age-sensitive and culturally adapted therapies, mindfulness and meditation-based stress reduction, group therapy, digital mental health resources, and psilocybin-assisted group therapy as emerging intervention models tailored to meet the unique needs of SGM OALWH.

Is Pollution the Primary Driver of Infectious Syndemics?

Syndemics, the adverse interaction of two or more coterminous diseases or other negative health conditions, have probably existed since human settlement, plant and animal domestication, urbanization, and the growth of social inequality beginning about 10-12,000 years ago. These dramatic changes in human social evolution significantly increased opportunities for the spread of zoonotic infectious diseases in denser human communities with increased sanitation challenges. In light of a growing body of research that indicates that anthropogenic air pollution causes numerous threats to health and is taking a far greater toll on human life and wellbeing than had been reported, this paper proposes the possibility that air pollution is now the primary driver of infectious disease syndemics. In support of this assertion, this paper reviews the growth and health impacts of air pollution, the relationship of air pollution to the development and spread of infectious diseases, and reported cases of air pollution-driven infectious disease syndemics, and presents public health recommendations for leveraging the biosocial insight of syndemic theory in responding to infectious disease.

Human Immunodeficiency Virus in the South: An Epidemic Within an Epidemic.

The authors examine the HIV epidemic in the Southern United States, emphasizing its severe impact on minority and young populations. The authors highlight challenges including limited health care access, systemic racism influencing social determinants of health, and lesbian, gay, bisexual, transgender, and queer+ stigma. The South faces a critical human immunodeficiency virus (HIV) workforce shortage, especially in rural areas, and struggles with coexisting syndemics like other sexually transmitted infections and substance-use disorders. The authors describe comprehensive strategies such as Medicaid expansion, workforce enhancement, stigma reduction, and policy reforms to improve HIV prevention and treatment, emphasizing the need for a multifaceted approach to improve health outcomes for those living with HIV in the South.

Sex differences in houselessness, injection drug use, and mental health conditions among people newly diagnosed with HIV in Manitoba, Canada from 2018 to 2021: a retrospective cohort study.

Background: Manitoba saw the highest number of new HIV diagnoses in the province's history in 2021 and is the only Canadian province not meeting any of the previous UNAIDS 90-90-90 targets. Our goal was to describe sex differences and syndemic conditions within an incident HIV cohort in Manitoba, and the HIV treatment initiation and undetectable viral load outcomes. Methods: This was a retrospective cohort study of all people 18 years and older newly diagnosed with HIV in Manitoba, Canada between January 1st, 2018 and December 31st, 2021. Data was collected as follows: before HIV diagnosis: chlamydia, gonorrhoea, syphilis, and/or hepatitis C antibodies. At the time of HIV diagnosis: age, sex, gender, race/ethnicity, sexual orientation. During follow-up: CD4 counts, viral load, HIV treatment, hospitalizations, and number of visits to HIV care. Main exposures evaluated: methamphetamine use, injection drug use, houselessness, and mental health conditions. Outcomes: started antiretroviral treatment and achieved an undetectable viral load. A descriptive statistical analysis was used. Findings: There were 404 new HIV diagnoses in Manitoba from 2018 to 2021; 44.8% were female, 55.2% male; 76.% self-identified as Indigenous, 13.4% white/European, 4.7% African/black; 86.6% cis-gender; 60.9% heterosexual, 13.4% gay, bisexual and men who have sex with men, and 1.7% lesbian. Injection drug use was reported by 71.8% and 43.5% of females and males respectively. Methamphetamine was the most frequently injected drug (62.4%). Amongst females, 81.8% experienced at least one of the following: houselessness (43.1%), mental health comorbidities (46.4%), and injection drug use (71.8%). Only 64.9% of all individuals had an undetectable viral load (61.1% females and 67.9% males), 56.5% among people experiencing houselessness, 59% among young people (≤29 years), and 60.1% among people who inject drugs. Interpretation: People newly diagnosed with HIV in Manitoba are disproportionately experiencing houselessness, mental illness, and injection drug use (mostly methamphetamine). This pattern is more pronounced for female individuals. These findings highlight the need for syndemic and gender-specific approaches, simultaneously addressing social and health conditions, to treat HIV. Funding: This work was supported by the Canadian Institutes of Health Research, The Manitoba Medical Service Foundation, The James Farley Memorial Fund and the Canada Research Chairs Program.

Shedding light on the next pandemic path, from outpatient to ICU, the effect of vitamin D deficiency in the SARS-CoV-2 pandemic.

Background: Vitamin D insufficiency is named "the pandemic of our era" by some experts. World Health Organization warns against a "deadlier outbreak" than the COVID-19 pandemic. Critical evidence is hereby for future pandemic prevention, with special emphasis on Vitamin D. Methods: A cross-sectional study was conducted with 172 unvaccinated adult participants, who presented to the emergency department. Blood measurements, radiological findings, and demographic features were evaluated in the four categories of "healthy adults, COVID-19 outpatients, hospitalized inpatients on the wards, and in the ICU." Results: Results were statistically significant in association with age, gender, weight, Vitamin D, glucose, urea, creatinine, leucocyte, aspartate transaminase, hemoglobin, C-reactive protein, troponin, platelet/thrombocyte, ferritin, D-dimer, triglycerate, glycated haemoglobin, lactate dehydrogenase measurements, and chest computed tomography features (each p < 0.050). Conclusion: This article presents evidence to support the importance of Vitamin D for global public health. Patients with adequate levels of Vitamin D, glucose, urea, creatinine, leucocyte, aspartate transaminase, hemoglobin, C-reactive protein, troponin, platelet/thrombocyte, ferritin, D-dimer, triglycerate, glycated haemoglobin, lactate dehydrogenase are less likely to be admitted to ICU versus being outpatients. Factors include gender, age, weight, comorbidities, and computed tomography findings. The ultimate goal is to globally minimize preventable burdens of disease and death.

Examining a syndemic framework for HIV and Sexually Transmitted Infections Risk in Cali, Colombia / Examinando un marco sindémico para el VIH y el riesgo de infecciones de transmisión sexual en Cali, Colombia / Examinando um marco sindémico para o vih e o risco de infeções de transmissão sexual em Cali, Colômbia

Objective: We examined the role played by four psychosocial conditions: forced sex, early sexual initiation, and misuse of alcohol and illicit drugs on the risk of HIV and sexually transmitted infections in Cali-Colombia between 2013 and 2015. Methods: Using data from an HIV counseling and testing campaign in Cali, Colombia, we tested the effect of the accumulation and interactions of the four psychosocial conditions on both outcomes. Results: A total of 604 participants were representative subjects from key affected communities: men who have sex with men, transgender women and female sex workers. A total of 733 participants were heterosexual women and men. Only drug abuse was associated with HIV positivity (Prevalence ratio=2.3, CI 95%: 1.3­4.1), while all psychosocial conditions were associated with sexually transmitted infection history. The accumulation of the syndemic conditions was related to a higher likelihood of sexually transmitted infection history. None of the interactions tested was significant. Conclusions: Our findings highlight the importance of comprehensive mental health interventions in addressing HIV epidemics in Colombia.

Objetivo: Examinar el papel desempeñado por cuatro afecciones psicosociales: sexo forzado, iniciación sexual temprana, uso inadecuado de alcohol y drogas ilícitas en el riesgo de VIH e infecciones de transmisión sexual, en Cali-Colombia entre 2013-2015. Métodos: Utilizando datos de una campaña de consejería y pruebas de VIH en Cali, Colombia, probamos el efecto de la acumulación e interacciones de las cuatro condiciones psicosociales en la positividad al VIH y la positividad a otras enfermedades de transmisión sexual. Resultados: 604 participantes de las principales comunidades afectadas: hombres que tienen sexo con hombres, mujeres transgénero y trabajadoras sexuales. 733 participantes mujeres y hombres heterosexuales. Solo, abuso de drogas se asoció con positividad VIH (Razón de prevalencia = 2.3, IC 95%: 1.3­4.1), mientras que, todas las condiciones psicosociales se asociaron con historia de infecciones de transmisión sexual. La acumulación de condiciones sindémicas se relacionó con mayor probabilidad de historia de infecciones de transmisión sexual. Ninguna interacción probada fue significativa. Conclusiones: Nuestros hallazgos resaltan la importancia de intervenciones integrales de salud mental para abordar la epidemia de VIH en Colombia

Objetivo: Examinar o papel desempenhado por quatro afeções psicossociais: sexo forçado, iniciação sexual precoce, uso inadequado de álcool e drogas ilícitas no risco de VIH e infeções de transmissão sexual, em Cali-Colômbia entre 2013-2015. Métodos: Utilizando dados duma campanha de aconselhamento e testes de VIH em Cali, Colômbia, testamos o efeito da acumulação e interações das quatro condições psicossociais na positividade ao VIH e a positividade a outras doenças de transmissão sexual. Resultados: 604 participantes das principais comunidades afetadas: homens que tem sexo com homens, mulheres transgênero e trabalhadoras sexuais. 733 participantes mulheres e homens heterossexuais. Só, abuso de drogas se associou com positividade VIH (Razão de prevalência = 2.3, IC 95%: 1.3­4.1), enquanto que, todas as condições psicossociais se associaram com história de infeções de transmissão sexual. Acumulação de condições sindémicas (palavra que reúne o social e o biológico) se relacionou com maior probabilidade de história de infeções de transmissão sexual. Nenhuma interação provada foi significativa. Conclusões: Nossos descobrimentos ressaltam a importância de intervenções integrais de saúde mental para abordar a epidemia de VIH na Colômbia.

Examining a syndemic framework for HIV and sexually transmitted infections risk in Cali, Colombia / Examinando un marco sindémico para el VIH y el riesgo de infecciones de transmisión sexual en Cali, Colombia / Examinando um marco sindémico para o vih e o risco de infeções de transmissão sexual em Cali, Colômbia

Abstract Objective: We examined the role played by four psychosocial conditions: forced sex, early sexual initiation, and misuse of alcohol and illicit drugs on the risk of HIV and sexually transmitted infections in Cali-Colombia between 2013 and 2015. Methods: Using data from an HIV counseling and testing campaign in Cali, Colombia, we tested the effect of the accumulation and interactions of the four psychosocial conditions on both outcomes. Results: A total of 604 participants were representative subjects from key affected communities: men who have sex with men, transgender women and female sex workers. A total of 733 participants were heterosexual women and men. Only drug abuse was associated with HIV positivity (Prevalence ratio=2.3, CI 95%: 1.3-4.1), while all psychosocial conditions were associated with sexually transmitted infection history. The accumulation of the syndemic conditions was related to a higher likelihood of sexually transmitted infection history. None of the interactions tested was significant. Conclusions: Our findings highlight the importance of comprehensive mental health interventions in addressing HIV epidemics in Colombia.

Resumen Objetivo: Examinar el papel desempeñado por cuatro afecciones psicosociales: sexo forzado, iniciación sexual temprana, uso inadecuado de alcohol y drogas ilícitas en el riesgo de VIH e infecciones de transmisión sexual, en Cali-Colombia entre 2013-2015. Métodos: Utilizando datos de una campaña de consejería y pruebas de VIH en Cali, Colombia, probamos el efecto de la acumulación e interacciones de las cuatro condiciones psicosociales en la positividad al VIH y la positividad a otras enfermedades de transmisión sexual. Resultados: 604 participantes de las principales comunidades afectadas: hombres que tienen sexo con hombres, mujeres transgénero y trabajadoras sexuales. 733 participantes mujeres y hombres heterosexuales. Solo, abuso de drogas se asoció con positividad VIH (Razón de prevalencia = 2.3, IC 95%: 1.3-4.1), mientras que, todas las condiciones psicosociales se asociaron con historia de infecciones de transmisión sexual. La acumulación de condiciones sindémicas se relacionó con mayor probabilidad de historia de infecciones de transmisión sexual. Ninguna interacción probada fue significativa. Conclusiones: Nuestros hallazgos resaltan la importancia de intervenciones integrales de salud mental para abordar la epidemia de VIH en Colombia.

Resumo Objetivo: Examinar o papel desempenhado por quatro afeções psicossociais: sexo forçado, iniciação sexual precoce, uso inadequado de álcool e drogas ilícitas no risco de VIH e infeções de transmissão sexual, em Cali-Colômbia entre 2013-2015. Métodos: Utilizando dados duma campanha de aconselhamento e testes de VIH em Cali, Colômbia, testamos o efeito da acumulação e interações das quatro condições psicossociais na positividade ao VIH e a positividade a outras doenças de transmissão sexual. Resultados: 604 participantes das principais comunidades afetadas: homens que tem sexo com homens, mulheres transgênero e trabalhadoras sexuais. 733 participantes mulheres e homens heterossexuais. Só, abuso de drogas se associou com positividade VIH (Razão de prevalência = 2.3, IC 95%: 1.3-4.1), enquanto que, todas as condições psicossociais se associaram com história de infeções de transmissão sexual. Acumulação de condições sindémicas (palavra que reúne o social e o biológico) se relacionou com maior probabilidade de história de infeções de transmissão sexual. Nenhuma interação provada foi significativa. Conclusões: Nossos descobrimentos ressaltam a importância de intervenções integrais de saúde mental para abordar a epidemia de VIH na Colômbia.