Syndemics Among Communities of Trans-Experience: A Systematic Review

Background and Purpose: Communities of trans-experience are among the most marginalized populations in the world. Current evidence indicates that the ostracism faced by communities of trans-experience lead to adverse health conditions related to mental health including depression, substance use, sexual and physical abuse as well as high rates of HIV/ STI risk behaviors. The synergistic impact of these conditions, otherwise referred to as syndemics, has been well established among other marginalized populations such as men who have sex with men. Yet, despite the disproportionate rates of syndemic conditions, there is a dearth of literature exploring their effect among communities of trans-experience.  This systematic review evaluates and summarizes the current state of the science examining syndemic conditions in  communities of trans-experience.

Methods: A comprehensive search of four databases (Medline, Embase, Global Health, and PsycInfo) was conducted; search terms included syndemics, syndemic theory, transgender, sexual minority and gender minority. References of selected articles were also reviewed. Articles that explored the impact of syndemic factors and/or theory among communities of trans-experience were critically appraised using AXIS, a 20-item scoring tool.

Results: The search generated 71 articles of which only eight met the inclusion criteria. The review revealed a lack of uniformity in syndemic measures and results were inconsistent. Half of the included studies were among adult transwomen (N=4), most were geographically located in the United States (N=6) and explored outcomes related to HIV risk behaviors such as condomless anal sex (N=5). In two of the included studies’ sample, men who have sex with men were also included where one found that transwomen had a higher likelihood of syndemics. Only one study conducted with young transwomen found a significant association of syndemic factors and sexual risk behavior. All of studies among transwomen 18 years of age and older found a significant association and their outcome of interest. Among transmen, syndemic conditions were found to be associated with sexual risk indicators. Discrimination, age, avoiding care and sexual orientation were also associated with a syndemic class in a study of transmen.

Conclusions and Implications: Understanding syndemics is vital to developing evidence based and contextually suitable approaches. Findings from this review underscores the need for multidisciplinary interventions particularly related to social and health related conditions and their interactions.