Syndemics Do Not Come Syndemics Do Not Come Out of a Vaccuum: Lessons Out of a Vaccuum: Lessons

Learned from ResearchLearned from ResearchDr. Trevor A. Hart

Associate ProfessorDepartment of Psychology

Ryerson University

Syndemics: Definition Syndemics: Definition (Singer, 1996; 2006)(Singer, 1996; 2006)Comes out of sociology

◦ Syn = working together◦ Demos = people

“A set of closely intertwined and mutual enhancing health problems that significantly affect the overall health status of a population within the context of a perpetuating configuration of noxious social conditions.” (p. 99)

Originally studied among Puerto Rican community in Hartford, CT

Concern that problems were often looked at in isolation from each other

Examines social context (e.g., migration, poverty, racism, marginalization)

The SAVA Epidemic (Singer, 1996)The SAVA Epidemic (Singer, 1996)

Examples of SyndemicsExamples of SyndemicsSAVA syndemic (substance abuse,

violence and AIDS) (Singer, 1996)Hookworm, malaria and HIV/AIDS

syndemic (Hotez, 2003)Malnutrition and depression syndemic

(Heflin, Siefert, & Williams, 2005) Mental health and HIV/AIDS syndemic

(Stall et al., 2003)

Confluence of Psychosocial RisksConfluence of Psychosocial Risks(Stall, Mills, Williamson, Hart, et al., 2003)(Stall, Mills, Williamson, Hart, et al., 2003)

2881 gay and bisexual male participantsExamined depression, childhood sexual

abuse, partner violence, and multiple drug use

The more of these psychological problems you have, the:◦Higher the risk of unprotected intercourse◦Higher the chances of being HIV+

Confluence of Psychological Confluence of Psychological RisksRisks

0

10

20

30

0 1 2 3

Unprotected Sex

HIV-Positive

Similar findings among heterosexual women (Cohen et al., 2000)

This suggests that interventions to reduce HIV risk should include interventions to reduce psychological problems

What Minority Stress Models What Minority Stress Models Tell Us About Health DisparitiesTell Us About Health Disparities

Gay Men’s Resilience in These Gay Men’s Resilience in These ModelsModels

How Homophobia Affects Health How Homophobia Affects Health Outcomes Among Gay MenOutcomes Among Gay Men

Minority Stress ModelMinority Stress Model(Meyer, 2003)(Meyer, 2003)

11

Psychological Mediation FrameworkPsychological Mediation Framework(Hatzenbuehler, 2009)(Hatzenbuehler, 2009)

Solving the Problem Solving the Problem LGBTQ

Equitable Health Access

Pride and Anti-Homophobic

Messaging for Gay Men

Anti-Homophobia

Education and Legislation

Solving the Problem Solving the Problem LGBTQ

Equitable Health Access

Pride and Anti-Homophobic

Messaging for Gay Men

Anti-Homophobia

Education and Legislation

Canadian Human Rights Code

Planned Parenthood’s

T.E.A.C.H. Program

Solving the Problem Solving the Problem LGBTQ

Equitable Health Access

Pride and Anti-Homophobic

Messaging for Gay Men

Anti-Homophobia

Education and Legislation

Canadian Human Rights Code

Planned Parenthood’s

T.E.A.C.H. Program

Solving the Problem Solving the Problem LGBTQ

Equitable Health Access

Pride and Anti-Homophobic

Messaging for Gay Men

Anti-Homophobia

Education and Legislation

Canadian Human Rights Code

Planned Parenthood’s

T.E.A.C.H. Program

CBRC’s Totally Outright Program,

GSA’s

Solving the Problem Solving the Problem LGBTQ

Equitable Health Access

Pride and Anti-Homophobic

Messaging for Gay Men

Anti-Homophobia

Education and Legislation

Canadian Human Rights Code

Planned Parenthood’s

T.E.A.C.H. Program

CBRC’s Totally Outright Program,

GSA’s

Solving the Problem Solving the Problem LGBTQ

Equitable Health Access

Pride and Anti-Homophobic

Messaging for Gay Men

Anti-Homophobia

Education and Legislation

Canadian Human Rights Code

Planned Parenthood’s

T.E.A.C.H. Program

CBRC’s Totally Outright Program,

GSA’s

Rainbow Health Ontario, Gay Poz Sex,

Sexual Confidence Program