Convergence between Cardiometabolic and Infectious Diseases in Adults from a Syndemic Perspective: A Scoping Review.

Objective. Synthesize the approaches used to study the convergence between cardiometabolic and infectious diseases in adults from a syndemic perspective based on the scientific evidence available to date worldwide. Methods. Scoping review that follows the recommendations of the PRISMA statement. The protocol was registered in INPLASY202150048. The search for studies was carried out in MEDLINE, LILACS, Web of Science and Scopus. Results. Since the COVID-19 pandemic, there has been an increase in studies in the field of convergence between cardiometabolic and infectious diseases from a syndemic perspective, but only three studies were classified as true syndemics. There are weaknesses in the adherence to the elements of the syndemic theory, given a low incorporation of population measurements, and until now it has not been possible to find convincing empirical evidence that supports the bio-bio interface. Quantitative methods predominated through models focused on "sum scores". Conclusions. Future studies should comprehensively address the elements of syndemics, review discrepancies between additive analyses versus other modeling, and incorporate the influence of large-scale social forces. The lack of these aspects distances studies from the notion of syndemic, bringing them closer to comorbidity or multimorbidity approaches.

Using a Syndemics Perspective to (Re)Conceptualize Vulnerability during the COVID-19 Pandemic: A Scoping Review.

Syndemics theory has been applied to study interactions between biomedical and social factors leading to the clustering of diseases. Because syndemics theory focuses on interactions that enhance risk, the concept of vulnerability is central to this approach. We conducted a scoping review to better understand how this theoretical framework helped to define, operationalize, and tackle issues of vulnerability during the COVID-19 pandemic. Original research, reviews, and opinion pieces elaborating on syndemics, vulnerability, and COVID-19, published between December 2019 and October 2022 and available from PubMed, were eligible. We analyzed 40 records and identified three framings of syndemics operating during this period: (1) interactions between COVID-19, diseases/health conditions, and specific social factors; (2) interactions between COVID-19 and social determinants of health; and (3) impacts of COVID-19 on specific populations. Emerging conceptualizations described vulnerability to COVID-19 as a systemic issue, explained the impact of COVID-19 control measures on increased vulnerability, and presented COVID-19 as a syndemic on its own. However, this theory's potential for deepening our understanding of vulnerability during this pandemic was constrained by superficial explorations of the interactions between biomedical and social spheres, and insufficient theoretical and methodological support from the social sciences.

Association of syndemic conditions and quality of life among people living with HIV/AIDS.

The syndemics theory seeks to understand the effect of multiple synergic problems in promoting poor health outcomes. To disentangle which and how syndemic conditions affect the quality of life (QoL) may be important to improve well-being of people living with HIV/AIDS (PLWHA). This study evaluates the association between syndemic conditions and QoL among PLWHA. We performed a secondary analysis using data obtained between 2014 and 2017 among PLWHA under care in Rio de Janeiro, Brazil. The outcomes were the six QoL domains (physical, psychological, level of independence, social relationships, environmental, and spirituality) measured through the World Health Organization Quality of Life in HIV infection scale, abbreviated version (WHOQOL-HIV-BREF). The independent variables were demographic and clinical characteristics, syndemic conditions (binge drinking, compulsive sexual behavior, polysubstance use, intimate partner violence, and depression), and syndemics (two or more syndemic conditions simultaneously). Bivariate analysis (t-test and ANOVA) and linear regressions were performed for each quality-of-life domain. The analytical sample comprised 1530 participants, mostly male at birth (64%) and with median age of 43 years. The syndemic conditions most frequently observed were binge drinking (56%), IPV (13%), and depression (9%). Both individual syndemic conditions and syndemics were associated with worse QoL. In the multivariate analysis, positive screening for depression was associated with worse QoL in all domains. Polysubstance users presented worse QoL at social and environmental domains. Intimate partner violence was associated with worse QoL at environment domain while binge drinking was associated with worse scores in the physical domain. The presence of syndemics increased the likelihood of worse scores in the psychological, social, and environment domains. Our study expands the understanding of QoL in PLWHA, as it considers a holistic/integral, multifactorial, and synergistic approach to the determinants of QoL. Seeking strategies that target syndemics may be important to improve patient-centered outcomes in health.Abbreviations: HIV/AIDS: human immunodeficiency virus/acquired immunodeficiency syndromeWHO: World Health OrganizationQoL: quality of lifeHRQoL: health-related quality of lifePLWHA: people living with HIV/AIDScART: combined antiretroviral therapyIPV: intimate partner violenceINI/FIOCRUZ: Evandro Chagas National Institute of Infectious DiseasesOswaldo Cruz FoundationSRH: self-rated healthVL: viral loadCD4: CD4 cell countNIAAA: National Institute on Alcohol Abuse and AlcoholismCSBcompulsive sexual behaviorWHO-ASSIST: alcoholsmoking and substance involvement screening test developed by the World Health OrganizationPHQ-2: Patient Health Questionnaire-2.

Localizing syndemics: A comparative study of hunger, stigma, suffering, and crime exposure in three Haitian communities.

Theoretically, disease syndemics are hyper-localized in the forms they take, but little empirical data show how localization manifests. We present a comparison across three sites in Haiti, from data collected in June-august 2017 testing for localizations of risks across three communities: rural farming, border town, and in a high gang-activity urban zone. First, we modeled survey responses collected from heads of 4055 geographically-sampled households via linear regression, considering additive and interaction effects of food insecurity, crime exposure, and discrimination on depression and anxiety levels. Exposure to food insecurity, crime exposure, and discrimination were each associated with more depression and anxiety symptoms. For those living in the urban zone, there was weak evidence of possible interactional risks between the three vulnerabilities, suggesting little meaningful localized syndemic patterning. Second, we conducted thematic and word-based semantic network analysis to identify if people themselves cognitively connected vulnerabilities of hunger/poverty, crime, and suffering/discrimination using 7321 text blocks from 95 semi-structured interviews/focus groups. Network visualization suggested people commonly connect these domains. While the patterns were localized, crime concerns were central to all networks. The domain connections expressed through people's own words were more complexly inter-related than was evident from the modeled survey data, and suggested counter-intuitive influences. The quantitative approach to modeling syndemic interactions suggests no apparent practical benefits to layering or combining local anticrime, anti-hunger, and anti-discrimination programming. However, the qualitative network analysis suggests that programming could none-the-less leverage the perceived connections across domains for more meaningful and effective interventions. For the broader study of syndemics, incorporating novel qualitative approaches clarifies that constituent processes are not just potentially localizing suffering, but are also extremely important in how people cognitively understand and organize their everyday lives.

Ecosyndemics: The potential synergistic health impacts of highways and dams in the Amazon.

Ecosyndemics refer to disease interactions that result from environmental changes commonly caused by humans. In this paper, we push scholarship on ecosyndemics into new territory by using the ecosyndemic framework to compare two case studies-the Southern Interoceanic highway in Peru and the Belo Monte hydroelectric dam in Brazil-to assess the likelihood of socio-environmental factors interacting and leading to ill health in a syndemic fashion. Assessing these two case studies using an ecosyndemic perspective, we find that the construction of dams and highways in tropical forests create the conditions for increases in vector-borne illnesses, surges in sex work and sexually-transmitted infections, and increased psychological stress resulting from violence, delinquency, and the erosion of social cohesion. We suggest that these processes could interact synergistically to increase an individual's immune burden and a population's overall morbidity. However, we find differences in the impacts of the Interoceanic highway and the Belo Monte dam on food, water, and cultural systems, and observed that community and corporate-level actions may bolster health in the face of rapid socio-ecological change. Looking at the case studies together, a complex picture of vulnerability and resilience, risk and opportunity, complicates straight-forward predictions of ecosyndemic interactions resulting from these development projects but highlights the role that the ecosyndemic concept can play in informing health impact assessments and future research. We conclude by proposing a conceptual model of the potential interactions between psychological stress, vector-borne illnesses, and sexaully-transmitted infections and suggest that future investigations of synergistic interactions among these factors draw from the biological, social, and ecological sciences.

Malnutrition, illness, poverty, and infant growth: A test of a syndemic hypothesis in Nuñoa, Peru.

The concept of syndemics provides an important framework for understanding the complex interactions of biological and social conditions. Its use in public health and epidemiological research has increased substantially in the past ten years. Many syndemic analyses rely on the use of a sum score and subsequently fail to demonstrate biological interaction, leading some scholars to question the utility of the syndemic approach. Here, we utilize data from 86 mother/infant pairs from the rural district of Nuñoa, Peru to test a potential syndemic relationship among infection, malnutrition and infant growth. Between 2014 and 2015, surveys were conducted to assess household wealth, sanitation, dietary diversity, and reported illness, while anthropometric measures of mothers and infants were conducted to assess nutritional status via height-for-age and weight-for-height z-scores. Ethnographic insight was used in the selection of key economic variables including the development of an agricultural wealth index. We then assessed whether this constellation of health outcomes met the criteria for a syndemic by performing a quantitative analysis in which we tested for (1) an association between economic marginalization and high-risk environments; (2) the concentration of malnutrition, poor growth, and infection; and (3) biological interaction among these health outcomes. We found that economic measures were associated with pathogenic and nutritional risk, and that these in turn were associated with infectious disease, nutritional status, and growth. However, we did not find evidence that the proposed syndemic met criteria (2) or (3). We conclude that, despite being both socially and biologically plausible, a syndemic of malnutrition, poor growth, and infection did not exist in this context. This analysis moves syndemic research forward by demonstrating that such hypotheses are falsifiable, thus presenting a process by which they may be tested and lending support to the use of syndemic theory as an effective analytic framework.

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.

Nonprescribed Sex Hormone Use Among Trans Women: The Complex Interplay of Public Policies, Social Context, and Discrimination.

Purpose: Trans women are systematically excluded from basic human rights, possibly due to social contexts of transphobia. In health care, such barriers may result in nonprescribed sex hormone use and lead to significant health complications. As few studies investigated this phenomenon, we analyzed factors associated with nonprescribed sex hormone use by trans women in seven municipalities of São Paulo, Brazil. Methods: Muriel was a cross-sectional study (2014/2015), in which 673 transgender people answered a face-to-face survey. This analysis focused on trans women (n=616). Poisson regression models were used to assess factors associated with nonprescribed sex hormone use. A direct acyclic graph was built with a priori knowledge on the matter and was used for covariate selection. Results: A total of 90.7% of participants reported ever taking sex hormones. Most of those detailed nonprescribed use, which was associated with sex work, starting to use hormones before 18, identifying as travesti and lower education. Having the chosen name honored in public health services was found to be protective against this outcome. Conclusion: A high proportion of nonprescribed sex hormone use was observed in our sample. Our findings suggest barriers to health care and the need for trans women to resort to medically unsupervised transition procedures. Among sex workers, this may also be due to higher economic and access needs than other groups. Ensuring social rights and providing adequate health care services may lessen nonprescribed sex hormone use, preventing subsequent risks and resulting in better health outcomes for trans women.

Syndemic Experiences, Protective Factors, and HIV Vulnerabilities Among Lesbian, Gay, Bisexual and Transgender Persons in Jamaica.

Syndemics approaches explore the convergence of psychosocial factors that elevate HIV vulnerabilities. Less research has explored syndemics among lesbian, gay, bisexual and transgender (LGBT) persons in contexts where criminalization has downstream impacts on LGBT discrimination, such as Jamaica. We implemented a cross-sectional survey with LGBT persons (n = 911) in Jamaica. We conducted structural equation modeling to examine direct and indirect effects of a latent syndemics construct (binge drinking, depressive symptoms, childhood/adult abuse) on HIV vulnerabilities (lifetime sex partners, perceived HIV risk, condom self-efficacy) and the mediating role of protective factors (social support, resilient coping). Direct paths from syndemics to lifetime sex partners, perceived HIV risk, and condom self-efficacy were significant. Resilient coping and social support partially mediated the association between syndemics and condom use self-efficacy. Resilient coping partially mediated the relationship between syndemics and lifetime sex partners. Interventions can target syndemic issues to reduce HIV vulnerabilities among Jamaican LGBT persons.

Syndemics of Severity and Frequency of Elder Abuse: A Cross-Sectional Study in Mexican Older Females.

Background: Elder abuse is a common phenomenon with important effects on the health and well-being of older adults. There are important gaps in elder abuse measurement, as it is usually reported as the absence or presence of elder abuse, disregarding its severity and frequency. Objectives: Identify different ways of measuring severity and frequency of elder abuse and assess whether different experiences of severity and frequency suggest syndemic relationships. Methods: Through a sample of 534 non-institutionalized Mexican older women, we assessed how severity (i.e., number of abusive experiences and number of types of abuses) and frequency (i.e., if abusive experiences had happened few or many times) correlate among them. For each of these measures we estimated a multinomial model to examine associations with social support, functional impairments, socioeconomic status, food insecurity, depression, and comorbidities, while controlling for key socio-demographic variables. Results: 30.5% of the older women reported psychological abuse, 8.2% financial exploitation, 5.1% caregiver neglect, 3.5% physical abuse, and 1.2% sexual abuse. In terms of frequency, 77.8% of the women self-reported having never been abused or only once in the last 12 months, whereas 13.1% reported abusive experiences repeating few times, and 9.9% repeating many times. In terms of severity, 66.7% of the older women had not been abused, 22.3% had suffered one type of abuse, and 11.1% two or more. Similarly, 15.0% reported one abusive experience, 8.1% two, and 10.3% three or more abusive events during the last 12 months. Severity measures showed similar associations: social support and high socioeconomic level as protective factors among those with less severe abuse, whereas increased depression, food insecurity and functional impairments were associated with more severe experiences of elder abuse. Frequency followed a different pattern, depressive symptoms were significantly associated with those with few experiences (compared to those with none or once), while functional impairments were associated with many experiences of elder abuse. Conclusions: It is relevant to assess elder abuse through its severity and frequency as inter-individual variability and the complexity of the experience shows different determinants suggesting a syndemic approach. This has important clinical and policy implications.

"Outness" as a Moderator of the Association Between Syndemic Conditions and HIV Risk-Taking Behavior Among Men Who Have Sex with Men in Tijuana, Mexico.

Multiple psychosocial conditions tend to co-occur and contribute to higher risk for HIV among men who have sex with men (MSM), a phenomenon known as syndemics. Less is known about moderating factors that may attenuate the relation between syndemic conditions and sexual risk-taking. We examined disclosure of same-sex sexual behavior or "outness" as a moderating factor of the syndemic effect. We recruited a sample of MSM (n = 191) using respondent-driven sampling in Tijuana, Mexico. Participants completed a survey of syndemic conditions (i.e., substance use, depression, violence, internalized homophobia, and sexual compulsivity), sexual risk-taking (i.e., condom unprotected anal sex with a stranger in the past 2 months), and the degree to which they are "out" about sex with men. Consistent with previous research, we found that men who report more syndemic conditions show a greater prevalence of sexual risk-taking. As predicted, men who were out to more people showed a weaker association between syndemic conditions and sexual risk-taking, whereas men who were out to fewer people showed the strongest association. This study is the first to provide evidence of "outness" as a moderating factor that attenuates syndemic effects on sexual risk-taking. Building upon previous research, the data suggest that "outness" may be a resilience factor for MSM in Tijuana. HIV prevention intervention implications are discussed.