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.

Exploring the syndemic interaction between social, environmental and structural contexts of HIV infection in peri-mining areas in South Africa: a qualitative study.

OBJECTIVE: To explore the syndemic interaction between social, environmental, and structural contexts and HIV infection in peri-mining areas in South Africa. DESIGN: Mixed qualitative methods consisting of in-depth interviews (IDIs) and focus group discussions (FGDs) exploring the interaction between HIV infection and the social, environmental and structural factors affecting people living in the peri-mining areas of South Africa. Themes were analysed following the syndemic theoretical framework. SETTING: Participants were recruited from three mining companies and locations in the peri-mining communities surrounding the mining companies in Limpopo, Mpumalanga, and Northern Cape provinces. PARTICIPANTS: Inclusion criteria included mineworkers, healthcare workers, female sex workers (FSWs), injection drug users (IDUs), and other community members, ≥18 years, living in the peri-mining area at the time of participation. Three FGDs were conducted (n=30): 13 men and 17 women aged 18-55 years. IDIs were conducted with 45 participants: mineworkers (n=10), healthcare workers (n=11), FSWs (n=15), truck drivers (n=4) and IDUs (n=5). RESULTS: The findings from this study indicate that a syndemic of four socio-behavioural factors is associated with HIV acquisition in peri-mining areas. These are migrancy, accessibility to alcohol and substance use, commercial and transactional sex, and uptake of HIV prevention services. CONCLUSIONS: Our findings have implications for HIV prevention programmes in mining companies, which rely on male condom usage promotion. More emphasis on better education about HIV prevalence, transmission and up-to-date prevention alternatives, such as pre-exposure prophylaxis for mineworkers is recommended. Furthermore, collaboration with community-based organisations is recommended to wholly address the syndemic factors influencing HIV transmission in peri-mining communities.

The collaborative framework for the management of tuberculosis and type 2 diabetes syndemic in low- and middle-income countries: a rapid review.

INTRODUCTION: Given the absence of international guidelines on the joint management and control of tuberculosis (TB) and type 2 diabetes mellitus (T2D), the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (The Union) launched in 2011 a policy framework to address the growing syndemic burden of TB-T2D. This review aimed at mapping the available evidence on the implementation of the Union-WHO Framework, explicitly, or bi-directional TB-T2D health programs as an initiative for co-management in patients in low- and middle-income countries (LMIC). METHODS: A rapid review was performed based on a systematic search in PubMed and Web of Science electronic databases for peer-reviewed articles on The Union-WHO Framework and bi-directional interventions of TB and T2D in LMIC. The search was restricted to English language articles and from 01/08/2011 to 20/05/2022. RESULTS: A total of 24 articles from 16 LMIC met the inclusion criteria. Four described the implementation of The Union-WHO Framework and 20 on the bi-directional interventions of TB and T2D. Bi-directional activities were found valuable, feasible and effective following the Union-WHO recommendations. Limited knowledge and awareness on TB-T2D comorbidity was identified as one of the barriers to ensure a functional and effective integration of services. CONCLUSIONS: This review revealed that it is valuable, feasible and effective to implement bi-directional TB and T2D activities (screening and management) according to the Union-WHO Framework recommendations, especially in countries that face TB-T2D syndemic. Additionally, it was apparent that gaps still exist in research aimed at providing evidence of costs to implement collaborative activities. There is need for TB and T2D services integration that should be done through the well-stablished TB programme. This integration of two vertical programmes, could ensure patient-centeredness, continuum of care and ultimately contribute for health systems strengthening.

Understanding psychosis complexity through a syndemic framework: A systematic review.

Psychotic conditions pose significant challenges due to their complex aetiology and impact on individuals and communities. Syndemic theory offers a promising framework to understand the interconnectedness of various health and social problems in the context of psychosis. This systematic review aims to examine existing literature on testing whether psychosis is better understood as a component of a syndemic. We conducted a systematic search of 7 databases, resulting in the inclusion of five original articles. Findings from these studies indicate a syndemic characterized by the coexistence of various health and social conditions, are associated with a greater risk of psychosis, adverse health outcomes, and disparities, especially among ethnic minorities and deprived populations. This review underscores the compelling need for a new paradigm and datasets that can investigate how psychosis emerges in the context of a syndemic, ultimately guiding more effective preventive and care interventions as well as policies to improve the health of marginalised communities living in precarity.

The Mata Cavalo/Brazil quilombo and the COVID-19 syndemic: racism and the right to (r)exist in question. / O quilombo Mata Cavalo/Brasil e a sindemia da COVID-19: o racismo e o direito de (r)existir em questão.

Quilombola communities have felt the effects of racism deepened by COVID-19, whose repercussions are amplified in contexts of racial inequalities, characterizing it as a syndemic. The term refers to the synergy of biological, economic, environmental, political, and social elements that enhance coexisting conditions and states, impacting life and affecting health. Thus, our study seeks to analyze the repercussions of the COVID-19 syndemic based on the perceptions of quilombola community leaders in Mato Grosso, Brazil. In a qualitative study, three leaders were interviewed in May 2022, using a semi-structured script and treating the data through thematic analysis. The COVID-19 syndemic highlighted the structural precariousness of transport, roads, sanitation, and access to water, food, and health services. Isolation, deaths, and fears had psychosocial repercussions, but little attention was paid to mental health. Anti-racist proposals call for: repairing precariousness by recognizing the State's debt to the black population; valuing experiences, way of life, cosmovision, and Afro-centered ancestral civilizational values. Finally, the aim is to strengthen, reaffirm, and implement anti-racist actions, such as the Statute of Racial Equality and the PNSIPN, in all possible spaces, policies, and institutions.

Comunidades quilombolas têm sentido efeitos do racismo aprofundados com a COVID-19 cujas repercussões se amplificam em contextos de desigualdades raciais, caracterizando-se como sindemia. O termo remete à sinergia de elementos biológicos, econômicos, ambientais, políticos e sociais que potencializam condições e estados coexistentes, repercutindo na vida e afetando a saúde. Assim, analisamos as repercussões da sindemia da COVID-19 a partir das percepções de lideranças de comunidade quilombola em Mato Grosso. Em estudo qualitativo entrevistamos três lideranças em maio/2022, usando roteiro semiestruturado e tratamos os dados pela análise temática. A sindemia da COVID-19 visibilizou a precariedade estrutural quanto ao transporte, estradas, saneamento, acesso à água, alimentos e serviços de saúde. O isolamento, mortes, medos tiveram repercussões psicossociais, mas ausência de atenção à saúde mental. Propostas antirracistas clamam por: reparar precariedades reconhecendo a dívida do Estado com a população negra; valorizar experiências, modo de vida, cosmovisão, valores civilizatórios ancestrais afrocentrados. Enfim, fortalecer, reafirmar e efetivar ações antirracistas como o Estatuto da Igualdade Racial e a PNSIPN em todos possíveis espaços, políticas e instituições.

Do syndemic conditions predict HIV medication adherence among urban African American men?

Much progress has been made in advancing antiretroviral (ART) adherence, yet disparities remain. To explore relationships of syndemic conditions - co-occurring health conditions caused by combinations of biological, social, and structural factors - to ART adherence among African American men, we used data from longitudinal assessments of 302 African American men enrolled in a study designed to increase physical activity and healthy eating. Syndemic conditions included alcohol dependency, drug dependency, depression, post-traumatic stress disorder, and unstable housing. A syndemic conditions variable was operationalized to indicate the presence of 0-5 conditions. About 55% of participants had 1 or more syndemic conditions. Age and marriage were positively associated with ART adherence, whereas number of syndemic conditions was negatively associated with adherence during the 12-month period. The interaction of being married and the syndemic conditions variable significantly predicted greater adherence. Similarly, the interaction of more education and the syndemic conditions variable predicted greater adherence. In multiple regression models, the syndemic conditions variable remained significant (-0.018) in predicting adherence; however, there was no significant interaction among the 5 conditions. This study lends evidence to syndemics literature indicating deleterious consequences of negative life experiences on health outcomes.

Beyond tuberculosis: a person-centred and rights-based approach to screening for household contacts.

Households affected by tuberculosis have syndemic vulnerability, reflecting a concentration of and interactions between multiple biomedical, psychosocial, and structural determinants of health. Traditional approaches to tuberculosis screening do not address pre-existing risks, such as undernutrition and other chronic conditions, or the indirect effects of tuberculosis, such as loss of livelihood. These pre-existing risks and consequences not only perpetuate the global tuberculosis epidemic but, for those affected, lead to poor health and deepen poverty. We propose reimagining tuberculosis screening as an opportunity to deliver a contextually relevant package of services that address the needs of households affected by tuberculosis. This approach puts people and their rights at the centre of efforts to end tuberculosis, and has equity at the core. This approach could support progress towards universal health coverage, benefiting communities and health systems. Leadership, flexibility in funding allocation, and innovative care models will be required to realise this approach at scale.

Airways Type-2 Related Disorders: Multiorgan, Systemic or Syndemic Disease?

Chronic rhinosinusitis (CRS) has recently undergone a significant paradigm shift, moving from a phenotypical classification towards an "endotype-based" definition that places more emphasis on clinical and therapeutic aspects. Similar to other airway diseases, like asthma, most cases of CRS in developed countries exhibit a dysregulated type-2 immune response and related cytokines. Consequently, the traditional distinction between upper and lower airways has been replaced by a "united airway" perspective. Additionally, type-2 related disorders extend beyond respiratory boundaries, encompassing conditions beyond the airways, such as atopic dermatitis. This necessitates a multidisciplinary approach. Moreover, consideration of possible systemic implications is crucial, particularly in relation to sleep-related breathing diseases like Obstructive Sleep Apnoea Syndrome (OSAS) and the alteration of systemic inflammatory mediators such as nitric oxide. The trends in epidemiological, economic, and social burden are progressively increasing worldwide, indicating syndemic characteristics. In light of these insights, this narrative review aims to present the latest evidence on respiratory type-2 related disorders, with a specific focus on CRS while promoting a comprehensive perspective on the "united airways". It also introduces a novel concept: viewing these conditions as a multiorgan, systemic, and syndemic disease.

Structural and Psychosocial Syndemic Conditions and Condomless Anal Intercourse Among Transgender Women - National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019-2020.

Psychosocial and structural syndemic conditions, including polydrug use and experiencing homelessness, frequently co-occur and might jointly increase HIV risk. Limited studies have assessed racial and ethnic differences in exposure to syndemic conditions and behaviors associated with HIV transmission among transgender women. This report examines the relation between syndemic conditions and condomless anal intercourse (CAI) among transgender women in seven urban areas in the United States to develop HIV prevention interventions for transgender women. During 2019-2020, transgender women in seven urban areas were recruited using respondent-driven sampling for a biobehavioral survey. Reported syndemic conditions (psychosocial: polydrug use, sexual violence, and psychological distress; structural: homelessness, incarceration, and exchange sex) were summed to create a syndemic score. Using modified Poisson regression to account for RDS, the study assessed whether the strength of the association between syndemic score and CAI differed by race and ethnicity. To assess additive interaction, the relative excess prevalence owing to interaction (REPI) and 95% CIs for selected pairs of syndemic conditions on CAI prevalence stratified by race and ethnicity were estimated. Of 1,348 transgender women (Black = 546, White = 176, and Hispanic = 626), 55% reported CAI; and 24% reported ≥3 syndemic conditions. Reporting additional syndemic conditions was associated with CAI for White, Hispanic, and Black participants. The association was significantly stronger for White than Black and Hispanic participants. Limited significant superadditive interactions were found, although the majority were between structural syndemic conditions. Racial and ethnic differences in REPI estimates were observed. Reporting more syndemic conditions was associated with increased CAI across racial and ethnic groups, demonstrating that HIV prevention efforts for transgender women should address structural and psychosocial syndemic conditions. Results differed by race and ethnicity, indicating that syndemic-focused interventions for transgender women should be tailored to racial and ethnic groups.

Evidence of syndemic effects influencing older transgender persons' likelihood of contemplating suicide: results from a large national study.

OBJECTIVES: Very little research has examined suicidal ideation or the factors associated with contemplating suicide among older transgender adults. This paper examines whether or not there is evidence of syndemic effects influencing suicidal ideation among transgender persons aged 50 or older. METHODS: Data from the 2015 U.S. National Transgender Survey were used to examine five domains of potentially-syndemic effects (workplace issues, interactions with professionals, using public services, personal safety, and socioeconomic disadvantages) in a sample of 3,724 transgender Americans aged 50 or older. A dichotomous measure of suicidal ideation during the past year was the main outcome measure. RESULTS: The odds of contemplating suicide increased anywhere from 96% to 121% among people experiencing any of the problems under study, and anywhere from 258% to 1,552% (depending upon the syndemic effect domain in question) when they were faced by all of the experiences included in any particular domain. When all items were combined, exposure to any of the domains' problems elevated the risk of contemplating suicide by 276% and exposure to all of the problems examined increased the risk by 861%. The syndemic effects measure remained significant in multivariate analysis controlling for the influence of other potentially-relevant factors. CONCLUSIONS: Considerable evidence for the presence of syndemic effects was found, demonstrating that the more different types of adverse conditions that older transgender person's face, the more likely they are to experience to contemplate suicide. There is evidence that these effects diminish with advancing age.

Exploring a syndemic of poverty, cumulative violence, and HIV vulnerability among refugee youth: multi-method insights from a humanitarian setting in Uganda.

Synergistic associations between social inequities and HIV vulnerabilities - known as a syndemic - are understudied with youth in humanitarian settings. We explored refugee youths' HIV prevention needs in Bidi Bidi Refugee Settlement, Uganda. This multi-methods study involved 6 focus groups and 12 in-depth individual interviews (IDI) with refugee youth (n = 60) aged 16-24, and IDI with refugee elders (n = 8) and healthcare providers (n = 8). We then conducted cross-sectional surveys with refugee youth (16-24 years) (n = 115) to assess: poverty, recent sexual and gender-based violence (SGBV), and condom engagement motivation (CEM) (wanting to learn about condoms for HIV prevention). Multivariable logistic regression was used to estimate adjusted odds ratios for associations between poverty and SGBV with CEM. Qualitative narratives revealed poverty and trauma elevated substance use, and these converged to exacerbate SGBV. SGBV and transactional sex increased HIV vulnerabilities. Among survey participants, poverty and recent SGBV were associated with reduced odds of CEM. The interaction between poverty and recent SGBV was significant: the predicted probability of CEM among youth who experienced both poverty and SGBV was almost half than among youth who experienced poverty alone, SGBV alone, or neither. Findings signal the confluence of poverty, violence, and substance use elevate refugee youth HIV vulnerabilities.

The influence of a hostile environment on a syndemic of depression, stress and chronic limiting illness among LGBTQ+ people during the COVID-19 pandemic.

Lesbian, Gay, Bisexual, Transgender, Queer, Questioning (LGBTQ+) are at greater risk of poorer COVID-19 prognosis due to higher levels of chronic disease and a greater impact on mental health from pandemic mitigation strategies due to worse pre-pandemic mental health. We examine how a hostile social system contributes to LGBTQ+ people's negative health experiences during the pandemic through adopting a syndemic framework and using data from The Queerantine Study, a cross-sectional, web-based survey (n = 515). Identification of a health syndemic is based on depressive symptoms, perceived stress and limiting long-term illness. We used Latent Class Analysis to identify latent classes based on experiences of a hostile social system. A syndemic was identified among a third of respondents (33.2%), with transgender/gender-diverse and younger participants at higher risk. Latent Class Analysis identified five groups based on experiences of hostile social systems using psychosocial and socioeconomic indicators. Classes reflecting psychosocial hostility were predictive of a health syndemic and worsening health. This study emphasises (i) mental and physical health issues are intertwined among LGBTQ+ people; (ii) experiences of hostile social systems can account for part of variation in health across LGBTQ+ groups; (iii) that psychosocial hostility continued and was exacerbated throughout the pandemic, and (iv) experiences of psychosocial hostility in particular were associated with a greater likelihood of experiencing a syndemic.

Profiles of a COVID-19 Syndemic: Anti-Asian Racism, Economic Challenges, and Mental and Physical Health.

BACKGROUND: During the COVID-19 pandemic, Asians/Asian Americans have experienced co-occurring threats of anti-Asian racism, economic challenges, and negative mental and physical health symptoms. OBJECTIVES: We examined the co-occurrence of COVID-19-related anti-Asian discrimination and collective racism, economic stressors, and mental and physical health challenges for Asians/Asian Americans during the COVID-19 pandemic. We also examined Asian/Asian American subgroups associated with these threats. METHODS: Nationally representative data from the 2021 Asian American and Native Hawaiian/Pacific Islander COVID-19 Needs Assessment Project (unweighted N = 3,508) were used to conduct a latent profile analysis to identify unique typologies of the co-occurrence of these threats. We also conducted chi-square analyses to investigate subgroup differences by latent profile. RESULTS: We identified five distinct latent profiles: multi-threat impact, low impact, collective racism, health challenges, and economic/health challenges. Forty percent of Asians/Asian Americans were in the multi-threat impact profile, indicating high levels across COVID-19-related threats. Subgroup analyses revealed significant differences in profile membership. East Asians, US-born Asians/Asian Americans, and those aged 25-44 seemed to be particularly affected by the proposed syndemic; results also differed by income. CONCLUSION: Asians/Asian Americans have experienced co-occurring and interrelated threats during COVID-19 that suggest the presence of a syndemic. Results from our study point to vulnerable Asian/Asian American subgroups and the need for targeted public health efforts to address racism, health challenges, and economic challenges in the context of COVID-19.

A Mixed Methods Analysis of Southern HIV Service Organizations' Implementation of Harm Reduction to Address the HIV and Opioid Syndemic.

Southern HIV Service Organizations (SHSOs) are promising sites for the adoption and implementation of harm reduction as a means for addressing the HIV and opioid syndemic. However, little research to date has examined exactly how harm reduction is operationalized within and among SHSOs. Using program evaluation data (i.e., organizational assessment data and semi-structured qualitative group interview data with SHSO staff), this study aimed to characterize organizational implementation of harm reduction among SHSOs that sought harm reduction capacity-building assistance (i.e., training, coaching, funding) from the SUSTAIN Center. Authors utilized a convergent mixed methods design in which quantitative and qualitative approaches were employed in parallel to gain simultaneous insights into how harm reduction was operationalized in SHSOs and how the local context influenced implementation. Means and proportions of each organizational assessment domain were compared. Thematic analysis of group interview transcripts examined SHSO staff perceptions of harm reduction implementation in their respective communities. Quantitative results revealed that SHSOs most commonly operationalize harm reduction in the Outreach, Advocacy, and Principles domains but struggle to do so in terms of Services and Organizational Infrastructure. Qualitative results revealed that various factors in SHSOs' local context, such as the community's lack of knowledge and understanding of harm reduction, limited harm reduction services, and a challenging socio-political context, influence SHSOs implementation of harm reduction. Taken together, analyses reveal that (1) SHSOs expend significant effort conducting outreach activities because Southern communities are generally unaware of harm reduction, (2) SHSOs continually advocate for harm reduction in the midst of a challenging socio-political context, and (3) SHSOs offer fewer harm reduction services and integrate harm reduction into their organizational infrastructure to a lesser extent due to external, contextual factors. The combination of organizational-level data and SHSO staff insights provided by this mixed methods study have implications for policy advocacy, funding initiatives, and capacity-building efforts.

Health Inequities Among People Who Use Drugs in a Post-Dobbs America: The Case for a Syndemic Analysis.

Punitive policy responses to substance use and to abortion care constitute direct attacks on personal liberty and bodily autonomy. In this article, we leverage the concept of "syndemics" to anticipate how the already synergistic stigmas against people who use drugs and people who seek abortion services will be further compounded the Dobbs decision.

Impactos da covid-19: desafios da pandemia na perspectiva da comunicação e saúde / Impacts of covid-19: challenges of the pandemic in perspective of communication and health / Impactos del covid-19: desafíos de la pandemia en perspectiva de la comunicación y la salud

O ano de 2020 ficou marcado pelo surgimento da maior pandemia deste século, a covid-19. Somando-se às dificuldades impostas por uma emergência sanitária dessa amplitude, fomos desafiados também por fenômenos comunicacionais complexos, como a desinformação, a infodemia, a sindemia e as fake news, o que gerou a necessidade de a doença ser vista por perspectivas antes negligenciadas. O livro Desinformação e covid-19: desafios contemporâneos na comunicação e saúde oferece uma diversidade de análises e iniciativas para o enfrentamento das dificuldades fomentadas pela covid-19, a partir de diferentes concepções teóricas que buscam compreender as interfaces complexas que conectam a comunicação e a saúde. Como resultado, temos a expectativa de que se amplie a capacidade de garantirmos os direitos de cidadania, com uma saúde realmente equânime, universal e integral, oferecendo respostas melhores às crises que, porventura, estejam em nosso futuro

The year 2020 was marked by the emergence of the biggest pandemic of this century, covid-19. In addition to the difficulties imposed by a health emergency of this magnitude, we were also challenged by complex communicational phenomena, such as disinformation, infodemic, syndemic, and fake news, which generated the need for the disease to be seen from previously neglected perspectives. The book Disinformation and Covid-19: Contemporary Challenges in Communication and Health offers a diversity of analyses and initiatives to face the difficulties fostered by covid-19 from different theoretical conceptions that seek to understand the complex interfaces that connect communication and health. As a result, we expect that the capacity to guarantee citizenship rights will be expanded, with truly equitable, universal and comprehensive health, offering better responses to the crises that may be in our future

El año 2020 ha estado marcado por la aparición de la mayor pandemia de este siglo, el covid-19. Además de las dificultades que impone una emergencia sanitaria de esta envergadura, también nos hemos visto desafiados por complejos fenómenos de comunicación como la desinformación, la infodemia, la sindemia y las fake news, lo que ha llevado a la necesidad de contemplar la enfermedad desde perspectivas que hasta ahora se habían descuidado. El libro Desinformación y covid-19: desafíos contemporáneos en comunicación y salud ofrece una variedad de análisis e iniciativas para abordar las dificultades causadas por el covid-19 desde diferentes concepciones teóricas que buscan comprender las complejas interfaces que conectan la comunicación y la salud. Como resultado, tenemos la expectativa de que podemos ampliar nuestra capacidad para garantizar los derechos de la ciudadanía, con una salud verdaderamente equitativa, universal e integral, ofreciendo mejores respuestas a las crisis que pueden acechar nuestro futuro

Housing Insecurity and Other Syndemic Factors Experienced by Black and Latina Cisgender Women in Austin, Texas: A Qualitative Study.

Austin, Texas emerged as one of the fastest-growing cities in the U.S. over the past decade. Urban transformation has exacerbated inequities and reduced ethnic/racial diversity among communities. This qualitative study focused on housing insecurity and other syndemic factors among Black and Latina cisgender women (BLCW). Data collection from 18 BLCW using in-depth interviews guided by syndemic theory was conducted three times over three months between 2018 and 2019. Four housing insecurity categories emerged: (a) very unstable, (b) unstable, (c) stable substandard, and (d) stable costly. Participants who experienced more stable housing, particularly more stable housing across interviews, reported fewer instances of intimate partner violence (IPV), less substance use, and a reduced risk of acquiring HIV. Results identified the importance of exploring housing insecurity with other syndemic factors among BLCW along with determining structural- and multi-level interventions to improve housing circumstances and other syndemic factors. Future research should explore these factors in other geographic locations, among other intersectional communities, and among larger sample sizes and consider using a mixed methods approach.

Children of a syndemic: co-occurring and mutually reinforcing adverse child health exposures in a prospective cohort of HIV-affected mother-infant dyads in Cape Town, South Africa.

INTRODUCTION: Several HIV-related syndemics have been described among adults. We investigated syndemic vulnerability to hazardous drinking (HD), intimate partner violence (IPV) and household food insecurity (HFIS) in breastfed children born without HIV in urban South Africa. We compared those who were perinatally HIV exposed (CHEU) to those who were not (CHU), under conditions of universal maternal antiretroviral therapy (ART) and breastfeeding. METHODS: A prospective cohort of pregnant women living with HIV (WLHIV), and without HIV, were enrolled and followed with their infants for 12 months postpartum (2013-2017). All WLHIV initiated antenatal efavirenz-based ART. Measurements of growth (∼3 monthly), infectious cause hospitalisation, ambulatory childhood illness (2-week recall) and neurodevelopment (BSID-III, measured at ∼12 months' age) were compared across bio-social strata using generalised linear regression models, with interaction terms; maternal data included interview-based measures for HD (AUDIT-C), IPV (WHO VAW) and HFIS. RESULTS: Among 872 breastfeeding mother-infant pairs (n = 461 CHEU, n = 411 CHU), WLHIV (vs. HIV negative) reported more unemployment (279/461, 60% vs. 217/411, 53%; p = 0.02), incomplete secondary education (347/461, 75% vs. 227/411, 55%; p < 0.0001), HD (25%, 117/459 vs. 7%, 30/411; p < 0.0001) and IPV (22%, 101/457 vs. 8%, 32/411; p < 0.0001) at enrolment; and HFIS at 12 months (45%, 172/386 vs. 30%, 105/352; p > 0.0001). There were positive interactions between maternal HIV and other characteristics. Compared to food secure CHU, the mean difference (95% CI) in weight-for-age Z-score (WAZ) was 0.06 (-0.14; 0.25) for food insecure CHU; -0.26 (-0.42; -0.10) for food secure CHEU; and -0.43 (-0.61; -0.25), for food insecure CHEU. Results were similar for underweight (WAZ < -2), infectious-cause hospitalisation, cognitive and motor delay. HIV-IPV interactions were evident for ambulatory diarrhoea and motor delay. There were HIV-HD interactions for odds of underweight, stunting, cognitive and motor delay. Compared to HD-unexposed CHU, the odds ratios (95% CI) of underweight were 2.31 (1.11; 4.82) for HD-exposed CHU; 3.57 (0.84; 15.13) for HD-unexposed CHEU and 6.01 (2.22; 16.22) for HD-exposed CHEU. CONCLUSIONS: These data suggest that maternal HIV-related syndemics may partly drive excess CHEU health risks, highlighting an urgent need for holistic maternal and family care and support alongside ART to optimise the health of CHEU.