Intersecting Relationships of Psychosocial and Structural Syndemic Problems Among People with HIV in South Africa: Using Network Analysis to Identify Influential Problems

Jasper S Lee; Sierra A Bainter; Alexander C Tsai; Lena S Andersen; Amelia M Stanton; Jessica F Magidson; Ashraf Kagee; John A Joska; Conall O'Cleirigh; Steven A Safren

doi:10.1007/s10461-022-03906-z

Intersecting Relationships of Psychosocial and Structural Syndemic Problems Among People with HIV in South Africa: Using Network Analysis to Identify Influential Problems

AIDS Behav. 2023 Jun;27(6):1741-1756. doi: 10.1007/s10461-022-03906-z. Epub 2022 Oct 30.

Authors

Jasper S Lee^{1

2}, Sierra A Bainter³, Alexander C Tsai^{4

5}, Lena S Andersen⁶, Amelia M Stanton⁷, Jessica F Magidson⁸, Ashraf Kagee⁹, John A Joska¹⁰, Conall O'Cleirigh^{11

12}, Steven A Safren³

Affiliations

¹ Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Sq, 7th Floor, Boston, MA, 02114, USA. JLEE333@mgh.harvard.edu.
² Department of Psychiatry, Harvard Medical School, Boston, MA, USA. JLEE333@mgh.harvard.edu.
³ Department of Psychology, University of Miami, Coral Gables, FL, USA.
⁴ Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA.
⁵ Harvard Medical School, Boston, MA, USA.
⁶ Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
⁷ Department of Psychology, Boston University, Boston, MA, USA.
⁸ Department of Psychology, University of Maryland, College Park, MD, USA.
⁹ Department of Psychology, Stellenbosch University, Stellenbosch, Western Cape, South Africa.
¹⁰ HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
¹¹ Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Sq, 7th Floor, Boston, MA, 02114, USA.
¹² Department of Psychiatry, Harvard Medical School, Boston, MA, USA.

PMID: 36309936
PMCID: PMC10148921 (available on 2024-06-01)
DOI: 10.1007/s10461-022-03906-z

Abstract
in English, Spanish

In South Africa, little is known about interrelationships between syndemic problems among people with HIV (PWH). A better understanding of syndemic problems may yield important information regarding factors amenable to mitigation. We surveyed 194 PWH in Khayelitsha, outside of Cape Town, South Africa. We used network analysis to examine the frequency of 10 syndemic problems and their interrelationships. Syndemic problems among PWH in South Africa were common; 159 (82.8%) participants reported at least 2 co-occurring syndemic problems and 90 (46.9%) endorsed 4 or more. Network analysis revealed seven statistically significant associations. The most central problems were depression, substance use, and food insecurity. Three clusters of syndemics were identified: mood and violence; structural factors; and behavioral factors. Depression, substance use, and food insecurity commonly co-occur among PWH in sub-Saharan Africa and interfere with HIV outcomes. Network analysis can identify intervention targets to potentially improve HIV treatment outcomes.

En Sudáfrica, poco se sabe sobre interrelaciones entre problemas sindémicos entre personas con VIH (PCV). Un major entendimiento de los problemas sindémicos puede arrojar información importante sobre los factores susceptibles de mitigación. Utilizamos el análisis de redes para examinar la frecuencia de 10 problemas sindémicos y sus interrelaciones. Problemas sindémicos entre PCV en Sudáfrica eran communes; 159 (82.8%) participantes presentaron al menos 2 problemas sindémicos concurrentes y 90 (46.9%) presentaron 4 o más. El análisis de red reveló siete asociaciones estadísticamente significativas. Los problemas más centrales fueron la depresión, el uso de sustancias y la inseguridad alimentaria. Se indetificaron tres grupos de sindemias: estado de ánimo y violencia; factores estructurales; y factores de comportamiento. La depresión, el uso de sustancias y la inseguridad alimentaria comúnmente ocurren simultáneamente entre las PCV en el África subsahariana e interfieren con los resultados del VIH. El análisis de redes puede identificar objetivos de intervención para potencialmente mejorar los resultados del tratamiento del VIH.

Keywords: Global Mental Health; HIV; Network analysis; Syndemics.

MeSH terms

HIV Infections* / complications
HIV Infections* / epidemiology
HIV Infections* / psychology
Humans
Sexual Behavior / psychology
South Africa / epidemiology
Substance-Related Disorders* / complications
Substance-Related Disorders* / epidemiology
Substance-Related Disorders* / psychology
Syndemic

Abstract in English, Spanish

MeSH terms

Grants and funding

Abstract
in English, Spanish