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      A Syndemic of Psychosocial Problems Places the MSM (Men Who Have Sex with Men) Population at Greater Risk of HIV Infection

      research-article
      Author(s): , * , , ,
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      Publication date (Electronic):
      Journal: PLoS ONE
      Publisher: Public Library of Science

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          Abstract

          Background

          The MSM (Men who have sex with men) population suffers from very high rates of concurrent psychosocial problems. Together, these problems comprise a syndemic that increases the risk of HIV infection for this community. The precise mechanisms through which this syndemic can raise the likelihood of HIV infection warrant further exploration.

          Methodology/Principal Findings

          A total of 522 MSM were enrolled via a multiframe sampling approach and were asked to report psychosocial problems, risky sexual behaviors and HIV test results. A count of psychosocial health problems was calculated to test the additive relationship of these factors on HIV risk. Adjusting analysis and restriction analysis were used to determine a proposed intermediate pathway. Psychosocial health problems are highly concurrent and intercorrelated among urban MSM. Greater numbers of health problems are significantly and positively associated with HIV infection, which is mediated, at least partially, by risky sexual behaviors.

          Conclusions/Significance

          MSM experience concurrent psychosocial health problems that correlate with HIV infection in this community. We recommend the development of coping strategies for this population to deal with these psychosocial problems, both in prevention research and health policy.

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          Role of depression, stress, and trauma in HIV disease progression.

          Jane Leserman (2008)
          Despite advances in HIV treatment, there continues to be great variability in the progression of this disease. This paper reviews the evidence that depression, stressful life events, and trauma account for some of the variation in HIV disease course. Longitudinal studies both before and after the advent of highly active antiretroviral therapies (HAART) are reviewed. To ensure a complete review, PubMed was searched for all English language articles from January 1990 to July 2007. We found substantial and consistent evidence that chronic depression, stressful events, and trauma may negatively affect HIV disease progression in terms of decreases in CD4 T lymphocytes, increases in viral load, and greater risk for clinical decline and mortality. More research is warranted to investigate biological and behavioral mediators of these psychoimmune relationships, and the types of interventions that might mitigate the negative health impact of chronic depression and trauma. Given the high rates of depression and past trauma in persons living with HIV/AIDS, it is important for healthcare providers to address these problems as part of standard HIV care.
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            Fallibility in estimating direct effects.

            S. Cole, Miguel A. Hernán (2002)
            We use causal graphs and a partly hypothetical example from the Physicians' Health Study to explain why a common standard method for quantifying direct effects (i.e. stratifying on the intermediate variable) may be flawed. Estimating direct effects without bias requires that two assumptions hold, namely the absence of unmeasured confounding for (1) exposure and outcome, and (2) the intermediate variable and outcome. Recommendations include collecting and incorporating potential confounders for the causal effect of the mediator on the outcome, as well as the causal effect of the exposure on the outcome, and clearly stating the additional assumption that there is no unmeasured confounding for the causal effect of the mediator on the outcome.
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              Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder.

              Ashley K Vandermorris, S Austin, Heather Corliss … (2010)
              We assessed sexual orientation disparities in exposure to violence and other potentially traumatic events and onset of posttraumatic stress disorder (PTSD) in a representative US sample. We used data from 34 653 noninstitutionalized adult US residents from the 2004 to 2005 wave of the National Epidemiologic Survey on Alcohol and Related Conditions. Lesbians and gay men, bisexuals, and heterosexuals who reported any same-sex sexual partners over their lifetime had greater risk of childhood maltreatment, interpersonal violence, trauma to a close friend or relative, and unexpected death of someone close than did heterosexuals with no same-sex attractions or partners. Risk of onset of PTSD was higher among lesbians and gays (adjusted odds ratio [AOR] = 2.03; 95% confidence interval [CI] = 1.34, 3.06), bisexuals (AOR = 2.13; 95% CI = 1.38, 3.29), and heterosexuals with any same-sex partners (AOR = 2.06; 95% CI = 1.54, 2.74) than it was among the heterosexual reference group. This higher risk was largely accounted for by sexual orientation minorities' greater exposure to violence, exposure to more potentially traumatic events, and earlier age of trauma exposure. Profound sexual orientation disparities exist in risk of PTSD and in violence exposure, beginning in childhood. Our findings suggest there is an urgent need for public health interventions aimed at preventing violence against individuals with minority sexual orientations and providing follow-up care to cope with the sequelae of violent victimization.
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                Author and article information

                Contributors
                : Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2012
                Publication date (Electronic): 30 March 2012
                Volume: 7
                Issue: 3
                Electronic Location Identifier: e32312
                Affiliations
                [1]Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
                INSERM & Universite Pierre et Marie Curie, France
                Author notes

                Conceived and designed the experiments: LCY WJ. Performed the experiments: LCY WJ DXQ. Analyzed the data: WJ. Contributed reagents/materials/analysis tools: WH. Wrote the paper: WJ. Academic counseling: HLY.

                Article
                Publisher ID: PONE-D-11-12456
                DOI: 10.1371/journal.pone.0032312
                PMC ID: 3316524
                PubMed ID: 22479319
                SO-VID: 6aa9a9c0-38e9-4c15-8320-1d809aed0103
                Copyright © Jie et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                Date received : 4 July 2011
                Date accepted : 26 January 2012
                Page count
                Pages: 6
                Categories
                Subject: Research Article
                Subject: Medicine
                Subject: Epidemiology
                Subject: Infectious Diseases
                Subject: Viral Diseases
                Subject: HIV
                Subject: Public Health

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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