Syndemic analysis of co-occurring psychosocial health conditions and HIV infection in a cohort of men who have sex with men (MSM) in Bangkok, Thailand
K.S. McCarthy1,2, W. Wimonsate2, T. Guadamuz3, A. Varangrat2, S. Chaikummao2, A. Sangiamkittikul2, R. Stall3, F. van Griensven2,4
1Association of Schools of Public Health / Centers for Disease Control and Prevention Rosenfield Global Health Fellowship, Nonthaburi, Thailand, 2Thailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand, 3Graduate School of Public Health, University of Pittsburgh, Pittsburgh, United States, 4Centers for Disease Control and Prevention, Atlanta, United States
Background: HIV prevalence has increased in recent years in MSM in Bangkok, Thailand. This population may experience high levels of psychosocial health conditions, which may interact with HIV infection in a syndemic way. A syndemic is defined as a number of health conditions, interacting synergistically, contributing to excess burden of disease in a population.
Methods: Adult, Thai MSM (N=1,292) were recruited from MSM venues, internet and word of mouth for the Bangkok MSM Cohort Study. We used available baseline data to calculate bivariate odds ratios between pairs of psychosocial health conditions to see if they co-occurred. These conditions included being drunk 2-3 times per week or more, club drug use, selling sex, a history of forced sex, and reporting suicidal thoughts or actions. We evaluated whether an increase in number of conditions was associated with increasing HIV prevalence and unprotected anal sex in the past four months, using χ2 trend analysis.
Results: The prevalence of psychosocial health conditions was high: in the past four months, 12.7% reported drunkenness, 15.2% used club drugs, and 19.9% sold sex; in participants’ history, 18.9% experienced forced sex and 27.6% had suicidal thoughts or actions. These conditions significantly co-occurred with each other (all OR’s p< 0.05), except drunkenness with suicide (NS). Baseline HIV prevalence and unprotected anal sex was 22.5% and 55.3%, respectively. An increasing number of conditions was significantly and positively associated with increasing HIV prevalence (no condition=19.2%, 1 condition=21.6%, 2 conditions=26.7%, 3 condition=31.2%, 4-5 conditions=38.9%; p< 0.01) and unprotected anal sex (no conditions=49.9%, 1 condition=56.9%, 2 conditions=60.2%, 3 conditions=67.5%, 4-5 conditions=66.7%; p< 0.01).
Conclusions: Our results show an association between psychosocial health conditions and HIV prevalence among MSM in Bangkok. Further study of causal relationships between syndemic conditions and HIV incidence is necessary to support inclusion of simultaneous interventions in HIV prevention.