Syndemic Production of HIV Infection among Tanzanian MSM

Abstract

Tanzanian men who have sex with men (MSM) experience HIV disparity and are disproportionately vulnerable to psychosocial health problems together called SAVID (Substance abuse, childhood and adolescent sexual Abuse [CSA], anti-gay Violence, Internalized homonegativity [IH], and Depression). We applied syndemic theory to assess additive effects of the SAVID problems on HIV seropositivity among 300 MSM from two Tanzanian cities, who provided demographic, psychosocial health–problem, and HIV-status information. Prevalence rates of the problems were substance abuse during condomless sexual intercourse (37.3%), a history of CSA (35.3%), anti-gay violence (22%), high IH (52.7%), and depression (58%). Bivariate analysis showed a significantly positive “dose-response” relationship between the SAVID-problem count and HIV seropositivity: SAVID problems significantly increased the odds of HIV seropositivity (odds ratio, 1.42). This is the first study in sub-Saharan Africa to use syndemic theory to explore additive effects of coexisting psychosocial health problems on HIV seropositivity among Tanzanian MSM. Our results underscore the need for comprehensive HIV interventions targeting MSM.