Association Between Syndemic Events and HIV Infection Among Men Who Have Sex with Men in Taiwan

Background and purpose:

Multiple health problems occurring in a population simultaneously experiencing poor physical and social conditions comprise a syndemic. The examination of these health problems is critical to understanding the increased burden of disease among specific populations. Syndemic theory should be culturally specific as evidence suggests these conditions configure in unique ways according to race, ethnicity, and culture. Comprehensive information about Asian men who have sex with men (MSM) may contribute to complete understandings and more effective service provided by social workers in Taiwan. The current study aimed to examine a possible syndemic and its association with HIV infection among Taiwanese MSM. Understanding the phenomenon of the syndemic necessitates comprehensive assessment in order to offer comprehensive community services and curtail the epidemic for this key population.

Methods:

A cross-sectional survey was implemented using purposive sampling, and distributed in two LGBTQ community-based organizations. Informed consent was obtained prior to the survey. Participants completed questions about socio-demographic characteristics and their experience of six syndemic events: recreational drug use, binge drinking, intimate partner violence (IPV), multiple sexual partners, unprotected anal intercourse (UAI), and HIV stigma. Bivariate odds ratios were computed for each of the syndemic events and HIV status. HIV status was then operationalized as an outcome variable, and analyzed using multivariable logistic regression, controlling for socio-demographic factors.

Results:

Two hundred MSM completed the questionnaire for a response rate of 90.5%. The prevalence for each syndemic event was: high HIV stigma (54.8), multiple sex partner (48.0%), UAI (45.1%, excluded people who have no UAI), binge drinking (28.5%), recreational drug use (23.5%), IPV (16.6%), and HIV positive status (14.0%, excluded unknown status). The majority of participants (26%) experienced two syndemic events, with 35% of participants had two or more syndemic events. In the bivariate odds ratios, significant association were identified for: recreational drug use with binge drinking (OR = 2.97, CI=1.49-5.89), multiple sexual partners (OR = 2.08, CI = 1.06-4.06), and high HIV stigma (OR = 2.16, CI = 1.06-4.37); moreover, IPV was associated with UAI (OR = 2.56, CI = 1.04-6.26). In the multivariable logistic regression model, Taiwanese MSM who were older (AOR = 1.08, CI = 1.01 – 1.17), had lower income (AOR = 7.55, CI = 1.98 – 28.80), and had more syndemic events (AOR = 1.55, CI = 1.05 – 2.28) were more likely to be HIV positive.

Conclusions and Implication:

The results of this study provide evidence that syndemic affect on HIV infection among MSM in Taiwan. The co-occurring of multi-psychosocial problems among MSM in Taiwan magnifies the risk of HIV infection. Multivariable analyses suggest that lower income and increased syndemic is associated with HIV infection. The confluence of multiple psychosocial risk factors among MSM in Taiwan supports the need for social worker to conduct comprehensive assessment and to be aware of the association between syndemic factors and HIV infection. Social and behavioral research among MSM in diverse cultural settings may support the syndemic theory, which may facilitate service providers in applying a comprehensive biopsychosocial perspective in working with MSM.