title: The Utility of a Syndemic Framework in Understanding Chronic Disease Management Among HIV-Infected and Type 2 Diabetic Men Who Have Sex with Men.
abstract: Syndemic theory posits that epidemics of multiple physical and psychosocial problems co-occur among disadvantaged groups due to adverse social conditions. Although sexual minority populations are often stigmatized and vulnerable to multiple health problems, the syndemic perspective has been underutilized in understanding chronic disease. To assess the potential utility of this perspective in understanding the management of co-occurring HIV and Type 2 diabetes, we used linear regression to examine glycemic control (A1c) among men who have sex with men (MSM) with both HIV and Type 2 diabetes (n = 88). Bivariable linear regression explored potential syndemic correlates of inadequate glycemic control. Compared to those with adequate glycemic control (A1c ≤ 7.5 %), more men with inadequate glycemic control (A1c > 7.5 %) had hypertension (70 vs. 46 %, p = 0.034), high triglycerides (93 vs. 61 %, p = 0.002), depression (67 vs. 39 %, p = 0.018), current substance abuse (15 vs. 2 %, p = 0.014), and detectable levels of HIV (i.e., viral load ≥75 copies per ml blood; 30 vs. 10 %, p = 0.019). In multivariable regression controlling for age, the factors that were independently associated with higher A1c were high triglycerides, substance use, and detectable HIV viral load, suggesting that chronic disease management among MSM is complex and challenging for patients and providers. Findings also suggest that syndemic theory can be a clarifying lens for understanding chronic disease management among sexual minority stigmatized populations. Interventions targeting single conditions may be inadequate when multiple conditions co-occur; thus, research using a syndemic framework may be helpful in identifying intervention strategies that target multiple co-occurring conditions.
authors.affiliation: Fenway Community Health Center, 1340 Boylston Street, Boston, MA, 02215, USA.
authors.forename: Blaire
authors.initials: B
authors.lastname: Byg
authors.affiliation: Fenway Community Health Center, 1340 Boylston Street, Boston, MA, 02215, USA.|Department of Community Health Sciences, School of Public Health, Boston University, 801 Massachusetts Ave, Room 442E, Boston, MA, 02118, USA.
authors.forename: Angela Robertson
authors.initials: AR
authors.lastname: Bazzi
authors.affiliation: Fenway Community Health Center, 1340 Boylston Street, Boston, MA, 02215, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Funk
authors.affiliation: Fenway Community Health Center, 1340 Boylston Street, Boston, MA, 02215, USA.|Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
authors.forename: Bonface
authors.initials: B
authors.lastname: James
authors.affiliation: Fenway Community Health Center, 1340 Boylston Street, Boston, MA, 02215, USA. jpotter@bidmc.harvard.edu.|Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. jpotter@bidmc.harvard.edu.|Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA. jpotter@bidmc.harvard.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Potter
mesh_terms: D001294:Attitude to Health; D002908:Chronic Disease / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D019468:Disease Management; D057286:Electronic Health Records; D015658:HIV Infections; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Chronic disease management; Diabetes; HIV; MSM; Syndemics