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. 2023 Aug;20(4):206-217.
doi: 10.1007/s11904-023-00664-y. Epub 2023 Jul 24.

Spiraling Risk: Visualizing the multilevel factors that socially pattern HIV risk among gay, bisexual & other men who have sex with men using Complex Systems Theory

K Stojanovski  1 , E J King  2 , S O'Connell  3 , K S Gallagher  4 , K P Theall  5   3 , A T Geronimus  2   6
Affiliations

Spiraling Risk: Visualizing the multilevel factors that socially pattern HIV risk among gay, bisexual & other men who have sex with men using Complex Systems Theory

K Stojanovski et al. Curr HIV/AIDS Rep. 2023 Aug.

Abstract

Purpose of review: Global disparities in HIV infection, particularly among gay, bisexual, and other men who have sex with men (GBMSM), indicate the importance of exploring the multi-level processes that shape HIV's spread. We used Complex Systems Theory and the PRISMA guidelines to conduct a systematic review of 63 global reviews to understand how HIV is socially patterned among GBMSM. The purpose was to conduct a thematic analysis of the reviews to (1) synthesize the multi-level risk factors of HIV risk, (2) categorize risk across the socioecological model, and (3) develop a conceptual model that visualizes the interrelated factors that shape GBMSMS's HIV "risk."

Recent findings: We included 49 studies of high and moderate quality studies. Results indicated that GBMSM's HIV risk stems from the individual, interpersonal, and structural levels of the socioecological model. We identified a few themes that shape GBMSM's risk of HIV infection related to biomedical prevention methods; sexual and sex-seeking behaviors; behavioral prevention methods; individual-level characteristics and syndemic infections; lived experiences and interpersonal relationships; country-level income; country-level HIV prevalence; and structural stigma. The multi-level factors, in tandem, serve to perpetuate GBMSM's risk of HIV infection globally. The amalgamation of our thematic analyses from our systematic reviews of reviews suggests that the risk of HIV infection operates in an emergent, dynamic, and complex nature across multiple levels of the socioecological model. Applying complex systems theory indicates how multilevel factors create a dynamic and reinforcing system of HIV risk among GBMSM.

Keywords: Complex systems theory; GBMSM; Global health; HIV; Structural determinants; Systems science.

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Conflict of interest statement

The authors have no conflicts.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of the systematic review (n = 63)
Fig. 2
Fig. 2
Complex systems visualization of HIV risk among GBMSM, globally. Legend: Yellow: individual-level. Blue: interpersonal-level. Green: community-level. Purple: institutional-level. Red: structural-level
See this image and copyright information in PMC

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