Using Syndemics Theory to Investigate Risk and Protective Factors Associated with Condomless Sex Among Youth Living with HIV in 17 U.S. Cities.
Identifying risk and protective factors associated with condomless sex among youth living with HIV is imperative for developing effective HIV prevention strategies. A cross-sectional sample of 1728 participants, 12-26 years of age, recruited from adolescent medicine clinics in 17 U.S. cities completed an audio-computer assisted self-interview with questions about their substance use, psychosocial factors, and attitudinal and behavioral factors. Guided by syndemics theory, a path analysis was used to assess the interrelations of these factors. Analyses of model fit statistics indicated statistically significant direct pathways between substance use, psychosocial factors, self-efficacy for risk-reduction, alternative risk-reduction attitudes and behaviors and condomless sex. The total indirect effect of self-efficacy for risk-reduction on condomless sex through alternative risk-reduction attitudes and behaviors was also significant. Multi-faceted, tailored interventions that address individual risk and protective factors and their combined synergistic effects are urgently needed to prevent condomless sex among this population.
Division of Infectious Diseases, The Miriam Hospital, Providence, RI, USA. jacob_vandenberg@brown.edu.|Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA. jacob_vandenberg@brown.edu.|Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA. jacob_vandenberg@brown.edu.
Jacob J
JJ
van den Berg
Division of Health Professions, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.
M
M
Isabel Fernández
Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.
Joseph L
JL
Fava
Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA.
Don
D
Operario
Department of Pediatrics, New York University School of Medicine, New York, NY, USA.
Bret J
BJ
Rudy
Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
Patrick A
PA
Wilson
D000293:Adolescent; D001294:Attitude to Health; D002947:Cities; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D018451:Homosexuality, Male / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D065840:Protective Factors; D012309:Risk-Taking; D020377:Self Efficacy; D019966:Substance-Related Disorders / Q000453:epidemiology; D047568:Unsafe Sex / Q000706:statistics & numerical data*
Condomless sex; HIV prevention; Structural equation modeling; Syndemics theory; Youth living with HIV