Measurement model exploring a syndemic in emerging adult gay and bisexual men
Open accessAbstract
The current study was designed to develop a better understanding of the nature of the relationships between mental health burden, drug use, and unprotected sexual behavior within a sample of emerging adult gay and bisexual men, ages 18-19 (N = 598) and to test a theory of syndemics using structural equation modeling. Participants were actively recruited from community-based settings and the Internet for participation in a seven-wave cohort study. Data for participant characteristics and mental health were collected via computer-assisted survey, while drug use and unprotected sex behaviors for the month prior to assessment were collected via a calendar-based technique. Using the baseline data, we developed and tested structural equation models for mental health burden, drug use, and unprotected sex and also tested a second-order model for a single syndemic. First-order measurement models for each of the three epidemics were successfully identified using observed data. Tests of a second-order model seeking to explain the three epidemics as a single syndemic fit poorly. However, a second-order construct comprised of mental health burden and drug use fit the data well and was highly associated with the first-order construct of unprotected sex. The findings advance a theory of syndemics and suggest that in order to be maximally effective both HIV prevention and HIV care must be delivered holistically such that sexual risk behaviors are addressed in relation to, and in sync with, the drug use and mental health of the individual.
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The count variable approach has drawn limited criticism in the syndemics literature as overly simplistic.
“The count variable approach has received muted criticism in the syndemics literature for being too “simplistic” (Gebrekristos, 2010; Halkitis et al., 2013).”
From Syndemics of psychosocial problems and HIV risk: A systematic review of empirical tests of the disease interaction concept (2015) · cites this paper as Halkitis et al., 2013
In the Introduction (“The Present Study”; page unavailable), Halkitis et al. criticize additive syndemic measures for weighing variables equally and relying on simple correlations. The Discussion likewise contrasts prior summation-based studies with its more complex model. These passages support the criticism that the approach is simplistic, but do not establish that criticism across the literature was limited or “muted.” (LLM, conf=0.84)
Experimental — accuracy not yet measuredMost research on syndemics has focused on gay, bisexual, and other men who have sex with men.
“To date, the majority of research on syndemics has focused on GBMSM [37–42].”
From Using syndemics theory to investigate risk and protective factors associated with condomless sex among youth living with HIV in 17 U.S. Cities (2017) · cites this paper as [38]
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Flagged first, then by citations
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“(2014) and two other studies included in our review (Halkitis et al., 2013; Mustanski et al., 2014), may suggest ways to improve models in settings where this assumption is unwarranted.”
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- Authors
- Halkitis, P. N., Moeller, R. W., Siconolfi, D. E., Storholm, E. D., Solomon, T. M., & Bub, K. L.
- Affiliations
- New York University (US)
- Auburn University (US)
- Corresponding author
- Halkitis, Perry N.
- ORCID
- Venue
- AIDS and Behavior
- Published
- 2012-07-28
- Volume
- 17
- Issue
- 2
- Pages
- 662-673
- ISSN
- 1090-7165 (ISSN-L)
- 1573-3254
- PMC
- PMC3675898
- OpenAlex
- W2024499267
- Cited by
- 135
- References
- 35
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 5 · 2023: 6 · 2022: 9 · 2021: 13 · 2020: 11 · 2019: 10 · 2018: 9 · 2017: 10 · 2016: 21 · 2015: 19 · 2014: 11 · 2013: 5 · 2012: 1
- FWCI
- 8.59
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- AIDS and Behavior (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5r01da025537-11)
- National Institute on Drug Abuse (#R01DA025537)
- Topics
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
- Keywords
- syndemic, emerging adults, gay men, bisexual men, mental health burden, drug use, unprotected sex, HIV prevention, HIV care, measurement model, second-order construct, sexual risk behavior
- MeSH terms
- Adolescent, Bisexuality, Data Interpretation, Statistical, Humans, Health Knowledge, Attitudes, Practice, Male, Mental Health, Risk-Taking, Sexual Behavior, Sexual Partners, Social Support, United States, Models, Statistical, Cohort Studies, HIV Infections, Condoms, Homosexuality, Male, Substance-Related Disorders, Young Adult
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