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.
Highlights
The syndemics theory posits that a “constellation of two or more afflictions can amplify the negative impact of one or more other health problems” [1]
We explored the following subjects: 1) the association of the accumulation of psychosocial factors with HIV positivity and history of sexually transmitted infections (STI), and whether or not it was consistent with previous studies; 2) the synergistic effects of the presence of two syndemic conditions on both outcomes (HIV positivity and history of STIs), and; 3) the variation of these two outcomes with gender/sexuality, that is if the associations and interactions found are consistent in all groups
We observed a high prevalence of psychosocial conditions in the sample studied: 298 (22.5%), 510 (38.2%), and 312 (23.5%), 62 (4.6%), participants reported early sexual initiation, alcohol misuse, polydrug use, and forced sex, respectively
Summary
The syndemics theory posits that a “constellation of two or more afflictions can amplify the negative impact of one or more other health problems” [1]. The most frequent underlying psychosocial conditions that increase the risk of acquiring HIV and other sexually transmitted infections (STI) are drug and alcohol abuse, any experience of violence, and mental health problems [2]. Epidemiologic studies have found that the risk of HIV infection [3] and the prevalence of STIs [4, 5] increase as the number of those psychosocial conditions increases. Some studies have reported the synergistic effects of such psychosocial conditions. Tomori et al [5] reported that the combination of alcohol dependence and illicit drug use increases the risk of active syphilis beyond their independent effects. Chakrapani et al [6] found synergistic effects of violence and alcohol use as well as violence and depression on unprotected anal sex acts
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