Syndemic theory, structural violence and HIV among African-Americans

Purpose of review This paper will review recent use of syndemic frameworks in HIV research among African-Americans. Recent findings Researchers have used syndemic theory in diverse African-American study populations, including MSM, cis-women, trans-women, heterosexual men and adolescents. These studies have evaluated the associations between syndemic conditions and a variety of outcomes, such as sexual behaviours, HIV and other sexually transmitted infections, HIV testing, adherence to antiretroviral therapy, HIV suppression and preexposure prophylaxis use. The most frequently evaluated syndemic conditions have been depression, substance use and personal experience of abuse or violence; a few studies have included experience of incarceration and unstable housing. These studies have yielded valuable insights into links between HIV-related outcomes and mental health, experience of violence and abuse, and substance use. But a key feature - and major utility - of the syndemics framework is its potential for examining not only synergistic individual-level risk factors but also the interactions with economic, political and social systems that influence these individual-level factors and thereby shape the HIV epidemic among African-Americans. Research that takes these systems into account is needed to inform policy changes that can help end the HIV epidemic in this population.