Abstract
Globally, gay, bisexual and other men who have sex with men (GBMSM) experience an increased burden of poor sexual, mental and physical health. Syndemics theory provides a framework to understand comorbidities and health among marginalised populations. Syndemics theory attempts to account for the social, environmental, and other structural contexts that are driving and/or sustaining simultaneous multiple negative health outcomes, but has been widely critiqued. In this paper, we conceptualise a new framework to counter syndemics by assessing the key theoretical mechanisms by which pathogenic social context variables relate to ill-health. Subsequently, we examine how salutogenic, assets-based approaches to health improvement could function among GBMSM across diverse national contexts. Comparative quantitative secondary analysis of data on syndemics and community assets are presented from two international, online, cross-sectional surveys of GBMSM (SMMASH2 in Scotland, Wales, Northern Ireland and the Republic of Ireland and Sex Now in Canada). Negative sexual, mental and physical health outcomes were clustered as hypothesised, providing evidence of the syndemic. We found that syndemic ill-health was associated with social isolation and the experience of stigma and discrimination, but this varied across national contexts. Moreover, while some of our measures of community assets appeared to have a protective effect on syndemic ill-health, others did not. These results present an important step forward in our understanding of syndemic ill-health and provide new insights into how to intervene to reduce it. They point to a theoretical mechanism through which salutogenic approaches to health improvement could function and provide new strategies for working with communities to understand the proposed processes of change that are required. To move forward, we suggest conceptualising syndemics within a complex adaptive systems model, which enables consideration of the development, sustainment and resilience to syndemics both within individuals and at the population-level.
Highlights
Gay, bisexual and other men who have sex with men ( GBMSM) experience an increased burden of poor sexual, mental and physical health when compared to their heterosexual counterparts (Beyrer et al, 2016; Stall et al, 2016)
Marked inequalities in mental health have been reported in multiple studies, with gay and bisexual (GB) populations found to be at greater risk of suicide, mood disorders, and anxiety than heterosexual populations (King et al, 2008), and higher prevalence of acute and chronic physical conditions and
In SMMASH2, we found higher rates of concurrency of syndemic health outcomes than found in Natsal-3, for example, which found 8.4% of GBMSM reported all of the Evidence from SMMASH2
Summary
Gay, bisexual and other men who have sex with men ( GBMSM) experience an increased burden of poor sexual, mental and physical health when compared to their heterosexual counterparts (Beyrer et al, 2016; Stall et al, 2016). The need to intervene simultaneously at the individual-, networkand community-level to address syndemics has been contested and there is no evidence to demonstrate that interventions focused on a single issue might not be effective (Tsai et al, 2017) Conceptualising such health inequalities within a complex adaptive systems model sug gests health inequalities derive from multiple interrelated factors oper ating within a connected whole and it takes account of the social context within which people live, advocating that, rather than seeking solutions to individual problems, we should focus on how to change aspects of the system to promote positive change within it (Rutter et al, 2017). Salutogenic, community assets will have a protective effect on syn demic ill-health
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