A syndemic of psychosocial health problems increase risk for HIV among urban young men who have sex with men

BACKGROUND: Young men who have sex with men (YMSM) experience disparities in HIV rates and potentially in mental health, substance abuse, and exposure to violence. We assessed the extent to which these problems clustered together and had an additive effect on HIV risk. METHODS: An urban sample of 310 ethnically-diverse YMSM reported regular binge drinking, street drug use, regular marijuana use, psychological distress, intimate partner violence, and sexual assault. Youth also reported on sexual risk behaviors and HIV status. A count of psychosocial health problems was calculated to test the additive relationship to HIV risk using logistic regression models. RESULTS: The prevalence of psychosocial health problems varied from 23% for regular binge drinking to 34% for experiencing partner violence. Rates of sexual risk behaviors were high and 14% of YMSM reported receiving a HIV+ test result. Psychosocial health problems co-occurred, as evidenced by significant bivariate odds ratios between 12 of the 15 associations tested. Number of psychosocial health problems significantly increased the odds of having multiple anal sex partners (OR = 1.24), unprotected anal sex (OR = 1.42), and an HIV positive status (OR 1.42), after controlling for demographic factors. CONCLUSIONS: These data suggest the existence of co-occurring epidemics, or “syndemic,” of health problems among YMSM. Disparities exist not only in the prevalence of HIV among YMSM, but also in research to combat the epidemic within this population. Findings are discussed in the context of syndemic theory and the critical need for intervention development.