HIV Sexual Risk and Syndemics among Women in Three Urban Areas in the United States: Analysis from HVTN 906.
Limited data are available on the longitudinal occurrence of syndemic factors among women at risk for HIV infection in the USA and how these factors relate to sexual risk over time. HVTN 906 was a longitudinal study enrolling 799 HIV-uninfected women in three cities. Assessments were done at baseline, 6, 12, and 18 months to assess syndemic factors (low education, low income, unemployment, lack of health insurance, housing instability, substance use, heavy alcohol use, partner violence, incarceration) and sexual risk outcomes. For each sexual risk outcome, a GEE model was fit with syndemic factors or syndemic score (defined as sum of binary syndemics, ranging from 0 to 9), visit, study site, age and race/ethnicity as predictors to examine the multivariable association between syndemic factors and outcomes over time. Odds of unprotected sex while drunk or high were significantly higher when women reported lack of health insurance, substance and heavy alcohol use and partner violence. Housing instability, substance and heavy alcohol use, partner violence and recent incarceration were associated with higher odds of having multiple sexual partners. Odds of sex exchange were significantly higher in the presence of unemployment, housing instability, low education, lack of health insurance, substance and heavy alcohol use, partner violence and incarceration. Housing instability, substance and heavy alcohol use, and partner violence were significantly associated with higher odds of unprotected anal sex. Odds of having a recent STI were significantly higher when women reported housing instability and partner violence. There were significantly higher odds of the reporting of any risk outcomes during follow-up with higher syndemic score. This study highlights a group of women experiencing multiple poor social and health outcomes who need to be the focus of comprehensive interventions.
Laboratory of Infectious Disease Prevention, New York Blood Center, 310 E.67th Street, New York, NY, 10065, USA, bkoblin@nybloodcenter.org.
Beryl A
BA
Koblin
Shannon
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Grant
Victoria
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Frye
Hillary
H
Superak
Brittany
B
Sanchez
Debbie
D
Lucy
Debora
D
Dunbar
Parrie
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Graham
Tamra
T
Madenwald
Gina
G
Escamilia
Edith
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Swann
Cecilia
C
Morgan
Richard M
RM
Novak
Ian
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Frank
D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000209:etiology*; D006801:Humans; D000066511:Intimate Partner Violence / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult