Syndemic Factors, HIV Infection and Condom Use Among Men Who Have Sex with Men in Taiwan

Background and purpose

Syndemic theory has been productive in assessing sexual and other risk behaviours among men who have sex with men (MSM). This approach directs researchers to consider the influence of co-occurring and intersecting psychosocial problems on both increasing HIV infection and sexual risk behaviours among MSM. A wealth of evidence has found that co-occurring psychosocial problems were associated with one another, and an increase in syndemic factors was associated with HIV infection and condomless anal intercourse. In the current study, we examined the intersecting and additive effects of childhood physical abuse (CPA), childhood sexual abuse CSA), intimate partner violence (IPV), internalized homophobia (IH), and methamphetamine (meth) use on HIV infection and condom use among MSM in Taiwan.

Methods

A cross-sectional on-line survey was implemented using convenience sampling, and distributed from July-September 2017 through collaborative partnerships with five LGBTQ community-based organizations (CBOs) in three metropolitan cities and two rural cities in Taiwan. Informed consent was obtained prior to the survey. Participants completed questions about socio-demographic characteristics and their experience of five syndemic factors: CPA, CSA, IPV, IH, and meth use. Bivariate odds ratios were computed for each factor. HIV infection and inconsistent condom use were operationalized as outcome variables, and analyzed using multivariable logistic regression, controlling for socio-demographic factors.

Results

One thousand MSM completed the online survey. The prevalence of each syndemic factor was:  CPA (18.6%), CSA (14.0%), IPV (33.8%), IH (55.2%), and meth use (9.0%). A plurality of participants (41.6%) had experienced one factor, with 36.9% of participants having experienced two or more factors. Adjusted logistic regression models identified five syndemic factors as significantly related to at least one other factor. For additive effects, analysis revealed that Taiwanese MSM who were older (AOR = 1.11, CI = 1.07–1.14), self-identified as gay (AOR = 3.26, CI = 1.62–6.52), had a lower income (AOR = 0.49, CI = 0.29–0.83), and had increased syndemic factors were more likely to report as HIV seropositive. For the condom use model, participants who had increased syndemic factors were more likely to report inconsistent condom use. However, the condom use model did not meet the assumption of homogeneity.

Conclusion and implication

We identified a link of five proposed syndemic factors with HIV infection among MSM in Taiwan. The results highlight the importance of preventing syndemic factors, including working to diminish exposure to violence and to reduce minority stressors within MSM in Taiwan. Furthermore, our findings suggest an additive effect of the five syndemic factors among MSM living with HIV in Taiwan, indicating that this population experiences a higher rate of multiple adverse experiences than those who are HIV seronegative. These results may have implications for social work practice. Sensitizing social workers with culturally competent case screening for childhood trauma history, intimate partner experiences, and current meth use may help identify MSM who bear high risk. Additionally, further evidence-based research among MSM may support social workers in applying a comprehensive biopsychosocial perspective in working with MSM.