Understanding the Syndemics of Psychosocial Challenges Linked to HIV Risk

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In the mid-1990s, a new term was introduced into the medical nomenclature that has become a sticking point for revisiting how we treat, prevent, and address various maladies. The term “syndemics” was first coined by Merrill Singer.

Numerous evidentiary papers and studies now use this phrase to highlight that considering “other” factors related to a disease leads to more effective treatment.

Syndemics became wildly popular during Covid 19. As more focus was placed on the adverse interactions between diseases and social conditions, new light shined down on how we perceived Covid 19 through the lens of politics, social welfare, and availability of services.

That same holistic lens can be applied to the perceptions of HIV in both historical and current contexts.

Think of this concept as a tangled bundle of yarn. Every single thread represents a complex and exciting challenge that causes a ripple effect through the rest of the ball.

Various threats could be issues like mental health (depression or anxiety), social problems (racism or poverty), and the actual risk of contracting HIV and, later, AIDS.

Instead of looking at a single classifier that causes HIV, we begin to paint a picture where threads are twisted and tangled so that when you pull on one, it directly affects another.

It can be a lot harder to treat HIV when the population you’re targeting doesn’t have the medical infrastructure to facilitate needle exchange or trained professionals for injections.

Or, if a population has inherent biases against a marginalized community, there is less awareness and education for what could actually be passing the virus from person to person.

The point is that all the various health and social issues we experience around HIV are intertwined.

Collectively, they can make the situation much more manageable or far worse, offering a complex web of challenges for those combating HIV throughout the world.

It has been around 42 years since the CDC first reported a rare pneumonia in five gay men. This marked the beginning of the HIV/AIDS epidemic that swept through news media and instantly cast the virus as a “gay disease.”

At the time, unfortunately, society held negative views of gay men, often unfairly linking them to a false perception of being unclean. All of which could not be further from the truth. 

From today’s perspective, although some might have held differing views on their lifestyle choices, there were chances to support and contribute to the greater good of society as a whole.

But herein lies the syndemics issue. When we paint a virus of any kind with the colors of racism, bias, bigotry, or other emotionally charged issues, we lose sight of the challenges that are present.

Depression and anxiety skyrocket, and the treatment necessary, as well as the education to prevent, help, and cure these diseases like HIV, go unfulfilled.

Another interesting example of the need for syndemic views related to methamphetamines. In most cases, the idea of HIV was directly related to gay sex.

However, a 2020 NIDA-supported study demonstrated that new HIV transmission among sexual minorities having sex with men who were also using methamphetamines spiked the instances of positive results. In other words, those looking to “party and play” were choosing not to use protection.

That same study also demonstrated those with higher instances of depression, anxiety, or bipolar disorders had higher HIV viral loads were less likely to take treatment or preventative medication.

Around 2.5 million people in the US use methamphetamines. Another 2.3 million Americans are diagnosed with bipolar. A staggering 280 million people worldwide suffer from depression.

All said and done, that opens a significant proportion of the population to the underlying syndemics issues, leading to higher instances of HIV transmission and risk.

Then there is the most significant factor – money. Around 6.1% of the population over the age of 18 does not have access to quality healthcare through a “normal” provider.

These patients failed to obtain needed care directly related to the cost. Healthcare expenses have increased from 5% of total GDP in 1960 to 18% in 2021. That has led to 1 in 10 adults (roughly 23 million) owing medical debt.

From a syndemics viewpoint, you have a growing population of people who have mental illness, journeying through gender and sexual identity, and trying to manage an increasing cost of healthcare.

If it weren’t for governmental programs like the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), we would not be experiencing a decline in current HIV transmission.

More needs to be done. We need to perceive treatment plans through a holistic lens. Patients suffering from depression, handling gender identity in the intensely charged political atmosphere, and those at most risk from sharing needles or taking codependent drugs, need compassion.

Instead of ostracizing these populations for political gain, we need to consider the underlying factors contributing to the mass proliferation of disease and viral contraction.

Imagine if everyone in the U.S. viewed Covid 19 as not a conspiracy. What if we didn’t immediately think of it as the “Chinese Flu” or caused by people spitting in one another’s mouths?

Remove your bias and look at the issue as if it were no different than washing our hands after using the restroom. Odds are, things would have happened differently. The same is valid for HIV or whatever new disease is around the corner. 

Hindsight is always 2020. We cannot judge people for the fear and confusion that erupts whenever a new virus is discovered. The HIV “craze” or the Covid 19 fearmongering go hand in hand with an underlying issue – syndemics treatment. 

Let’s pause to look at the entire picture of what is affecting the ebb and flow of viral movement through a population and treat each one of those threads as they appear.

Instead of kicking the ball of yarn down the road to future generations, we must make the hard choices now and listen to the evidence in front of us. 

There is a compromise we can make between ideological bias and intrinsic data. We can provide empathy instead of roadblocks, and maybe, just maybe, our society will be able to uncover new and innovative techniques to treat those in less fortunate situations – whatever they might be.


Written by: Emmanuel J. Osemota

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