Substance Abuse, Violence, and HIV Risk Behavior in El Salvador and the United States: Cross-National Profiles of the Sava Syndemic
Syndemic theory posits that diseases and health conditions frequently interact in the context of adverse socioenvironmental conditions in ways that undermine public health and social well-being (Singer, 2009). Drawing from this perspective, researchers have begun to examine the notion of the SAVA Syndemic, which refers to the deleterious interconnections between substance abuse, violence, and HIV/AIDS in many marginalized communities (Singer, 1996, 2006). While a growing number of studies have examined SAVA in minority communities in the United States (Feingold, 2009; Gonzalez-Guarda et al., 2011), few studies have examined these relationships cross-nationally or in developing nations that experience extremely high rates of violent activity such as El Salvador, Central America (UNODC 2011). Given this research gap, the aim of this study is to systematically examine the behavioral heterogeneity of high-risk youth in San Salvador, El Salvador and Pennsylvania, United States with respect to youth involvement in substance use, violence, and HIV risk behavior.
Structured interviews were administered to high-risk youth and juvenile offenders in San Salvador, El Salvador (N = 237) and Pennsylvania, United States (N = 253). In San Salvador, all respondents identified as Hispanic and were between the ages of 12 and 26 years (M = 19.62, SD = 3.25). In Pennsylvania, respondents were racially/ethnically diverse (African-American = 52%, Non-Hispanic white = 22%, Hispanic = 13%, other = 13%) with ages ranging between 13 and 19 years (M = 16.21, SD = 1.35). Statistical analyses were carried out in two sequential steps: First, in both the El Salvador and United States samples, latent class analysis was used to assign youth to latent behavioral subgroups in terms of self-reported involvement in substance use (alcohol, marijuana, illicit drugs), violence (fighting, weapon carrying, violent attacks), and HIV risk behavior (early sexual debut, unprotected sex, multiple partners). Next, the probability of membership in each of the latent classes was examined in reference to salient psychological factors, including: impulsivity, future orientation, empathy, peer antisociality, and community violence exposure.
Results of the latent class analyses revealed three class solutions in both sites. As hypothesized, a class of “SAVA Youth” characterized by universally elevated levels of substance use, violence, and HIV risk behavior was identified in both San Salvador (20.68%) and Pennsylvania (42.29%). In San Salvador, membership in the SAVA Youth class was associated with greater impulsivity, peer antisociality, and community violence exposure. In Pennsylvania, membership in the SAVA Youth class was associated lower empathy as well as greater peer substance use and community violence exposure.
Conclusions and Implications:
This study is among the first to provide cross-national evidence as to the syndemic relationship between substance use, violence, and HIV risk behavior in Latin America and the United States. Substantial proportions of youth were identified as reporting elevated levels of involvement in all three domains of SAVA risk behavior in San Salvador (21%) and Pennsylvania (42%). Findings provide important information of relevance to the design of intervention efforts for youth in marginalized communities in El Salvador and the United States.