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Characterising a syndemic among black women at risk for HIV: the role of sociostructural inequity and adverse childhood experiences
Tsuyuki, Kiyomi Chan, Erica Lucea, Marguerite B. Cimino, Andrea Rudolph, Abby E. Tesfai, Yordanos Campbell, Jacquelyn C. Catabay, Christina J. Stockman, Jamila K.
Tsuyuki, Kiyomi
Chan, Erica
Lucea, Marguerite B.
Cimino, Andrea
Rudolph, Abby E.
Tesfai, Yordanos
Campbell, Jacquelyn C.
Catabay, Christina J.
Stockman, Jamila K.
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Journal article
Date
2022-05-20
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Epidemiology and Biostatistics
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http://dx.doi.org/10.1136/sextrans-2021-055224
Abstract
Objectives: Black women disproportionately experience STIs (including HIV/AIDS), gender-based violence, substance misuse and mental health conditions. Addressing a gap in syndemic research, we characterised comorbidity overlap within the context of sociostructural inequities and adverse childhood experiences (ACEs) among black women in Baltimore, Maryland. Methods: Between 2015 and 2018, black women (n=305) were recruited from STI clinics in Baltimore, Maryland. Among those with complete survey data (n=230), we conducted a latent class analysis to differentiate women based on their profile of the following syndemic comorbidities: STIs, adult sexual victimisation, substance misuse and mental health disorders. We then examined the association between ACEs and syndemic latent class membership. Results: Thirty-three percent of women experienced three to nine ACEs before age 18 years, and 44% reported four to six comorbidities. The two-class latent class solution demonstrated the best fit model, and women were categorised in either class 1 (past-year STI; 59%) or class 2 (syndemic comorbidities; 41%). Women in class 2 were more likely to report unstable housing (10% vs 3%) and identify as bisexual/gay (22% vs 10%) than women in class 1. ACEs were significantly associated with an increased likelihood of class 2 membership. Conclusions: This study reinforces the importance of screening for ACEs and offering trauma-informed, integrated care for black women with syndemic comorbidities. It also highlights the critical nature of tailoring interventions to improve sociostructural equity, preventing and reducing syndemic development.
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Tsuyuki K, Chan E, Lucea MB, et alCharacterising a syndemic among black women at risk for HIV: the role of sociostructural inequity and adverse childhood experiencesSexually Transmitted Infections 2023;99:7-13.
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BMJ Publishing Group
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Sexually Transmitted Infections (STI), Vol. 99
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