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. 2023 Feb;99(1):7-13.
doi: 10.1136/sextrans-2021-055224. Epub 2022 May 20.

Characterising a syndemic among black women at risk for HIV: the role of sociostructural inequity and adverse childhood experiences

Kiyomi Tsuyuki  1 , Erica Chan  2 , Marguerite B Lucea  3 , Andrea Cimino  4 , Abby E Rudolph  5 , Yordanos Tesfai  2 , Jacquelyn C Campbell  4 , Christina J Catabay  2 , Jamila K Stockman  2
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Characterising a syndemic among black women at risk for HIV: the role of sociostructural inequity and adverse childhood experiences

Kiyomi Tsuyuki et al. Sex Transm Infect. 2023 Feb.

Abstract

Objectives Black women disproportionately experience STIs (including HIV/AIDS), gender-based violence, substance misuse and mental health conditions. Addressing a gap in syndemic research, we characterised comorbidity overlap within the context of sociostructural inequities and adverse childhood experiences (ACEs) among black women in Baltimore, Maryland. Methods Between 2015 and 2018, black women (n=305) were recruited from STI clinics in Baltimore, Maryland. Among those with complete survey data (n=230), we conducted a latent class analysis to differentiate women based on their profile of the following syndemic comorbidities: STIs, adult sexual victimisation, substance misuse and mental health disorders. We then examined the association between ACEs and syndemic latent class membership. Results Thirty-three percent of women experienced three to nine ACEs before age 18 years, and 44% reported four to six comorbidities. The two-class latent class solution demonstrated the best fit model, and women were categorised in either class 1 (past-year STI; 59%) or class 2 (syndemic comorbidities; 41%). Women in class 2 were more likely to report unstable housing (10% vs 3%) and identify as bisexual/gay (22% vs 10%) than women in class 1. ACEs were significantly associated with an increased likelihood of class 2 membership. Conclusions This study reinforces the importance of screening for ACEs and offering trauma-informed, integrated care for black women with syndemic comorbidities. It also highlights the critical nature of tailoring interventions to improve sociostructural equity, preventing and reducing syndemic development.

Keywords: genital diseases, female; race factors; sexual and gender minorities.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Predicted means of syndemic comorbidities by latent class membership of black women at risk for HIV in Baltimore, Maryland, November 2015–May 2018 (n=230).
Figure 2
Figure 2
Venn diagram of syndemic comorbidities among class 2 members by ACE score category (n=94). ACE, adverse childhood experience.
See this image and copyright information in PMC

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