HIV Risk, Mental Health, Substance Use, and Violence: A Syndemic Factor among Hispanic Men Who Have Sex with Men

De Santis, Joseph P.

Background: Hispanic men who have sex with men (MSM) experience high rates of HIV infection and sexually transmitted infections (STIs) (Centers for Disease Control and Prevention, 2014), mental health issues, substance abuse (De Santis, Layerla, Barroso, Gattamorta, Sanchez & Prado, 2012), and childhood and adult intimate partner violence (Feldman, Diaz, Ream & El-Bassel, 2007). In addition, some researchers that have studied Hispanic populations (e.g ., Gonzalez-Guarda, McCabe, Florom-Smith, Cianelli & Peragallo, 2011) have suggested that social factors such as socioeconomic disadvantage contributes to this intersecting cluster of illnesses that is termed the syndemic factor (Singer, 1996). Although this syndemic orientation has been well-described among the general population of MSM (Starks, Millar, Eggleston & Parsons. 2014), little is known about syndemics among Hispanic MSM.

Purpose: The purpose of this study was two-fold: 1) to determine if HIV risk, mental health, substance use, and violence comprise a syndemic model among Hispanic MSM, and 2) to determine if this syndemic model is related to socioeconomic factors.

Methods: Data for this study was obtained from a larger mixed method study that investigated high risk sex, mental health, substance use and violence among Hispanic MSM residing in South Florida (n = 125). Participants were recruited from agencies that provided services to Hispanic MSM. Participants completed a structured interview that included instruments that measured sexual risk, mental health, substance use, and childhood/adult violence. Structural equation modeling (SEM) will be used to test the syndemic factor model and the relationship of this model to social factors such as socioeconomic status, years living in the U.S., acculturation, etc.

Results: The participants ranged in age from 21-65 years (M = 43.02, SD = 10.34). The majority of the participants were born in Cuba (n = 66; 54.5%) and had lived in the U.S. for an average of 20.27 years (SD = 12.43, range = 0-62), and had an average of 14.37 years of education (SD = 3.19, range = 6-24). The majority of the participants (n = 77; 61.6%) completed the interview in Spanish and were not acculturated to mainstream U.S. culture. About one-third of the participants (33.6%; n = 42) reported incomes less than $1,000/month. Preliminary analysis indicates that a number of the participants engaged in high risk sex, were depressed, used substances such as cigarettes and alcohol, and had experienced childhood/adult violence. At the time of submission, SEM analysis has not been completed.

Conclusion: HIV risk, mental health, substance use, and violence comprise a syndemic for Hispanic MSM. Nurses and other healthcare providers interested in addressing health disparities among Hispanic MSM need awareness of this co-existing conditions. More research is needed to develop public health programs and interventions targeting these multiple health disparities among Hispanic MSM.