title: Substance use, mental illness, and familial conflict non-negotiation among HIV-positive African-Americans: latent class regression and a new syndemic framework.
abstract: We evaluated a synergistic epidemic (syndemic) of substance use, mental illness, and familial conflict non-negotiation among HIV-positive injection drug users (IDU). Baseline BEACON study data was utilized. Latent class analyses identified syndemic classes. These classes were regressed on sex, viral suppression, and acute care non-utilization. Females were hypothesized to have higher syndemic burden, and worse health outcomes than males. Nine percent of participants had high substance use/mental illness prevalence (Class 4); 23 % had moderate levels of all factors (Class 3); 25 % had high mental illness (Class 2); 43 % had moderate substance use/mental illness (Class 1; N = 331). Compared to Classes 1-3, Class 4 was mostly female (p < .05), less likely to achieve viral suppression, and more likely to utilize acute care (p < .05). Interventions should target African-American IDU females to improve their risk of negative medical outcomes. Findings support comprehensive syndemic approaches to HIV interventions, rather than singular treatment methods.
authors: Department of Surgery, Brigham and Women's Hospital, Harvard Schools of Medicine and Public Health, Center for Surgery and Public Health, One Brigham Circle, 1620 Tremont Street, Suite BC-4-020-U, Boston, MA, 02134, USA. arobinson21@bwh.harvard.edu.
authors: Allysha C
authors: AC
authors: Robinson
authors: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Amy R
authors: AR
authors: Knowlton
authors: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Andrea C
authors: AC
authors: Gielen
authors: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Joseph J
authors: JJ
authors: Gallo
mesh_terms: D000328:Adult; D001741:Black or African American; D015897:Comorbidity; D005195:Family Relations / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D012737:Sex Factors; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D014481:United States
keywords: African-Americans; HIV; Health disparities; Health services research; Injection drug use; Syndemic theory; Viral suppression