The Relationship Between Violence Syndemics and Sexual Risk Behaviors Among African American Adolescents: Implications for Future Research

"They Want to Take Care of Themselves to Take Care of Their Kids": Provider Focus Group Perspectives of Stress and Resilience in Parents Living With HIV and Their Children in the Southeast United States

ABSTRACT

Parents living with HIV (PLWH) are often affected by co-occurring trauma, substance use, and mental health concerns. These complex challenges may contribute to intergenerational transmission of health risk, yet few studies have examined how these challenges affect family well-being in HIV-affected families. HIV care providers' insights can inform prevention efforts. Our study used qualitative focus group methods in two Southeast US cities to explore providers' perceptions of PLWH's challenges navigating parenting and HIV-related concerns and strengths supporting positive adaptation. Six themes emerged: PLWH's challenges; strengths; COVID-19 impacts; impact of trauma, mental health, and substance use; supports needed; and engagement strategies. Providers highlighted trade-offs between parents' self-care and parenting and that parents often draw strength from their children. Challenges identified were both common to parenting and unique to living with HIV. Results underscore the need for multilevel prevention, including addressing basic needs; integration of mental health and medical services; and increased family services.

An exploratory study of community violence and HIV care engagement among Black gay and bisexual men

This study examined the relationship between exposure to community violence and HIV care engagement among 107 Black gay or bisexual men living with HIV in Chicago. Measures assessed the importance of demographic covariates (age, annual income, health insurance status, and years living with HIV), community violence exposures, mental health, social support, in explaining variations in missed doses of antiretroviral therapy (ART) medication and missed HIV care appointments. Results showed that participants who reported higher rates of exposure to community violence were two times more likely to have missed ART doses and HIV care appointments. Participants who reported depression scores were two times more likely to have greater non-ART adherence. Finally, older participants were more likely to report fewer missed ART doses. More research is needed to clarify the mechanisms between age or depression and ART adherence given community violence exposure. Health care providers should screen for depression when attempting to promote better ART adherence and keeping HIV care appointments for Black gay and bisexual men living with HIV. Younger Black gay and bisexual men living with HIV may be more vulnerable than older men for missed ART doses and may require additional screening and follow-up.

Can you See What We See? African American Parents' Views of the Strengths and Challenges of Children and Youth Living with Adversity

A premise of positive youth development is that social competencies can develop in adversity and co-exist with problem behaviors. This research tested whether African American youth ages 9-17 who had experienced significant family stressors would form groups that displayed combinations of adversity, problem behavior, and strengths. Parents of a nationally representative sample of African Americans children were interviewed on child difficulties and strengths as part of the CDC's 2019 National Health Interview Survey. About 15% of the national sample of African American youth had experienced violence or parental incarceration, depression, or drug abuse. Latent class analysis (LCA) using indicators of adversity and strengths identified four distinct classes. Class 1 included youth who experienced multiple adversities, exhibited few strengths, and were high in behavior problems. Members of both classes 2 and 3 were more likely to experience parental incarceration but exhibited altruism. Class 3 also experienced parental mental health problems. Members of class 4 had the highest exposure to violence but were comparatively high in altruism and affability. Regression analysis revealed that the groups differed from one another on emotional health but not on physical health controlling for age and gender. These findings support a focus by mental health prevention programs on building on the strengths of children growing up in adversity.

"The Fight is Two Times as Hard": A Qualitative Examination of a Violence Syndemic Among Young Black Sexual Minority Men

Young Black men who have sex with men (YBMSM) are disproportionately impacted by violence, including violence rooted in anti-Black racism, sexual identity bullying, and neighborhood violence rooted in structural racism and inequities. These multiple forms of violence are frequently co-occurring and interactive creating syndemic conditions that can negatively impact HIV care. This qualitative study is based on in-depth interviews with 31 YBMSM, aged 16-30 years, living with HIV in Chicago, IL, to examine how violence has impacted their lives. Using thematic analysis, we identified five themes that reflect how YBMSM experience violence at the intersection of racism, homonegativity, socioeconomic status, and HIV status: (a) the experience of intersectional violence; (b) long histories of violence contributed to hypervigilance, lack of safety, and lack of trust; (c) making meaning of violence and the importance of strength; (d) normalizing violence for survival; and (e) the cyclical nature of violence. Our study highlights how multiple forms of violence can accumulate across an individual's life and contribute to social and contextual situations that further contribute to violence and negatively impact mental health and HIV care.

Context, COVID-19 and comorbidities: exploring emergent directions in syndemics and HIV research

PURPOSE OF REVIEW

The purpose of this review is to identify themes across articles that aimed to explore HIV-related syndemics in 2020 and 2021 and to discuss their implications for research on syndemics.

RECENT FINDINGS

We identified 189 articles on syndemics between 2020 and 2021. Key themes across studies included COVID-19; mental health and psychosocial challenges; substance use; socio-structural factors; protective factors; and methodological approaches. COVID-19's implications for HIV syndemic research were discussed. Mental health and substance use research largely examined linkages with sexual practices or reduced HIV care retention. Researchers examined associations between socio-structural variables (e.g. poverty) and elevated HIV exposure, reduced HIV testing and poorer health. Concepts of water insecurity and 'ecosyndemics' were also raised, as was the importance of attending to noncommunicable diseases and comorbidities. Most studies did not assess interactions between health conditions, signalling the need for methodological grounding in the foundational concepts of syndemic theory.

SUMMARY

Most studies recommended that HIV prevention and care research attend to the interplay between poor mental health, substance use and multidimensional violence. Increased attention to structural factors, particularly exacerbated poverty in the COVID-19 pandemic, is required. Research can identify protective factors to harness to advance HIV prevention and care.