title: Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalization.
abstract: OBJECTIVE
  We assessed whether multiple psychosocial factors are additive in their relationship to sexual risk behavior and self-reported HIV status (i.e., can be characterized as a syndemic) among young transgender women and the relationship of indicators of social marginalization to psychosocial factors.
  
  
  METHODS
  Participants (n = 151) were aged 15 to 24 years and lived in Chicago or Los Angeles. We collected data on psychosocial factors (low self-esteem, polysubstance use, victimization related to transgender identity, and intimate partner violence) and social marginalization indicators (history of commercial sex work, homelessness, and incarceration) through an interviewer-administered survey.
  
  
  RESULTS
  Syndemic factors were positively and additively related to sexual risk behavior and self-reported HIV infection. In addition, our syndemic index was significantly related to 2 indicators of social marginalization: a history of sex work and previous incarceration.
  
  
  CONCLUSIONS
  These findings provide evidence for a syndemic of co-occurring psychosocial and health problems in young transgender women, taking place in a context of social marginalization.
authors.affiliation: Children's Memorial Hospital, Chicago, IL, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Brennan
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Kuhns
authors.forename: Amy K
authors.initials: AK
authors.lastname: Johnson
authors.forename: Marvin
authors.initials: M
authors.lastname: Belzer
authors.forename: Erin C
authors.initials: EC
authors.lastname: Wilson
authors.forename: Robert
authors.initials: R
authors.lastname: Garofalo
mesh_terms: D000293:Adolescent; D000328:Adult; D002641:Chicago / Q000453:epidemiology; D019548:Crime Victims / Q000706:statistics & numerical data; D003625:Data Collection; D017579:Domestic Violence / Q000706:statistics & numerical data; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D011584:Psychology / Q000706:statistics & numerical data*; D012307:Risk Factors; D012309:Risk-Taking; D012649:Self Concept; D012725:Sexual Behavior; D019966:Substance-Related Disorders / Q000453:epidemiology; D014189:Transsexualism / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D055815:Young Adult