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A Longitudinal Investigation of Syndemic Conditions Among Young Gay, Bisexual, and Other MSM: The P18 Cohort Study

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Abstract

The persistence of disparities in STI/HIV risk among a new generation of emerging adult gay, bisexual, and other men who have sex with men (YMSM) warrant holistic frameworks and new methodologies for investigating the behaviors related to STI/HIV in this group. In order to better understand the continued existence of these disparities in STI/HIV risk among YMSM, the present study evaluated the presence and persistence of syndemic conditions among YMSM by examining the co-occurrence of alcohol and drug use, unprotected sexual behavior, and mental health burden over time. Four waves of data, collected over the first 18 months of a 7 wave, 36-month prospective cohort study of YMSM (n = 600) were used to examine the extent to which measurement models of drug use, unprotected sexual behavior, and mental health burden remained consistent across time using latent class modeling. Health challenges persisted across time as these YMSM emerged into young adulthood and the measurement models for the latent constructs of drug use and unprotected sexual behavior were essentially consistent across time whereas models for mental health burden varied over time. In addition to confirming the the robustness of our measurement models which capture a more holistic understandings of the health conditions of drug use, unprotected sex, and mental health burden, these findings underscore the ongoing health challenges YMSM face as they mature into young adulthood. These ongoing health challenges, which have been understood as forming a syndemic, persist over time, and add further evidence to support ongoing and vigilant comprehensive health programming for sexual minority men that move beyond a sole focus on HIV.

Resumen

La persistencia en las disparidades del riesgo de ITS/VIH en la nueva generación de adultos emergentes que son gay, bisexuales o son hombres que tienen sexo con hombres, exige marcos holísticos y nuevas metodologías para la investigación de los comportamientos relacionados con ITS/VIH para este grupo. Con el fin de comprender mejor la persistencia de estas disparidades en el riesgo de ITS/VIH entre los hombres jóvenes que tienen sexo con hombres (HJSH), el presente estudio evaluó la presencia y persistencia de las condiciones sindémicas en este grupo, examinando la concurrencia entre el consumo de alcohol y drogas, el comportamiento sexual sin protección, y la carga en la salud mental de los participantes a través del tiempo. Cuatro mediciones de información de HJSH (n = 600), recolectadas durante los primeros 18 meses de un estudio longitudinal de 7 mediciones en el transcurso de 36-meses, fueron utilizadas para examiner el grado en el que el consumo de drogas, el comportamiento sexual sin protección, y la carga en la salud mental se mantienen constantes a través de tiempo, utilizando un modelo de clase latente. Desafíos en la salud son persistentes a través de tiempo para este grupo de HJSH mientras emergen a la vida adulta, y los modelos de medición utilizados para el uso de drogas y el comportamiento sexual sin protección muestran consistencia a través del tiempo, mientras que el modelo de carga en la salud mental varia en el tiempo. Además de confirmar que los modelos de medición utilizados son robustos, también capturamos una manera mas holística de entender las condiciones de salud relacionadas con el uso de drogas, sexo sin protección, y la carga en la salud mental, demostrando el desafiante proceso que viven los HJSH en el proceso de entrar en la vida adulta. Estos desafíos para la salud, que deben ser entendidos de manera sindémica, son persistentes a través del tiempo, y suman mayor evidencia en apoyo de un programa integral de salud en hombres de minorías sexuales con un enfoque mas amplio que solo VIH.

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Acknowledgments

This study was funded by the National Institute on Drug Abuse, Contract # R01DA025537.

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Correspondence to Perry N. Halkitis.

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Halkitis, P.N., Kapadia, F., Bub, K.L. et al. A Longitudinal Investigation of Syndemic Conditions Among Young Gay, Bisexual, and Other MSM: The P18 Cohort Study. AIDS Behav 19, 970–980 (2015). https://doi.org/10.1007/s10461-014-0892-y

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