title: Depression and social support among women living with the substance abuse, violence, and HIV/AIDS syndemic: a qualitative exploration.
abstract: BACKGROUND
  Intimate partner violence (IPV), HIV/AIDS, and substance use are described as the SAVA "syndemic" among low-income urban women because of their intersecting and synergistic presence in these women's lives. Depressive symptoms are significantly associated with these SAVA factors and although social support is potentially protective for depression, little is understood about its impact on depression associated with the SAVA syndemic.
  
  
  METHODS
  This paper investigates how women living with SAVA experience and describe depressive symptoms, and examines how the types of social support they access impact their experiences of SAVA and depressive symptoms. Qualitative, in-depth interviews were conducted with 24 HIV-positive, low-income, urban women who experienced IPV and used cocaine or heroin in their lifetime. Interviews were analyzed based on study aims, principles of thematic content analysis, and grounded theory.
  
  
  RESULTS
  Women identified multiple SAVA factors as catalysts for depression and noted their synergistic effect on depressive symptoms, which were both a trigger for and a result of drug use. Women accessed varying sources of social support to address their SAVA factors and associated symptoms of depression, relying on informal sources for instrumental support related to IPV and formal sources for support related to HIV, drug use, and depression.
  
  
  CONCLUSIONS
  These findings have important implications for health providers who serve SAVA-affected women, and suggest that comprehensively addressing all SAVA factors (and IPV in particular) and improving their access to quality social support at critical times is essential to improve their mental health.
authors.affiliation: Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: sillanga@jhsph.edu.
authors.forename: Samantha L
authors.initials: SL
authors.lastname: Illangasekare
authors.affiliation: Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
authors.forename: Jessica G
authors.initials: JG
authors.lastname: Burke
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Geetanjali
authors.initials: G
authors.lastname: Chander
authors.affiliation: Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Gielen
mesh_terms: D000328:Adult; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D008396:Maryland / Q000453:epidemiology; D008603:Mental Health; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data; D036301:Qualitative Research; D012747:Sexual Partners / Q000523:psychology*; D012944:Social Support; D012959:Socioeconomic Factors; D013179:Spouse Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires; D014505:Urban Population