The Syndemic of STDs among men who have sex with men
by Dale O’Leary:
Part I.
It has been over 30 years since the first gay[1] men were diagnosed with what would later be called AIDS. Since then over 300,000 men who have sex with men (MSM) have died of AIDS, and 6,000 are expected to die this year and every year for the foreseeable future. In 2008, 17,940 MSM were diagnosed with HIV infections, an increase of 17% from 2005. MSM accounted for 53% of all new infections. It is estimated that one half million MSM are currently infected with HIV. According to a report from the CDC, one in five sexually active gay and bisexuals is carrying the AIDS virus and nearly half of those infected don’t know it. MSM are 44 to 86 times more likely to be diagnosed HIV positive than men who don’t.[2]
The continuing spread of HIV among MSM is not a simple epidemic, but a syndemic.
A syndemic occurs when a number of different and interrelated health problems come together and interact. The various elements of the syndemic have an additive effect, each one intensifying the others. According to an article by Dr. Ron Stall and associates, an analysis of the data from a large number of studies reveals that:
…additive psychosocial health problems—otherwise known collectively as a syndemic—exist among urban MSM and that the interconnection of these problems functions to magnify the effects of the HIV/AIDS epidemic in this population. A variation of this question has been empirically tested since the very earliest days of the HIV/AIDS epidemic, in that substantial literature now exists on the relationship between substance use and HIV/AIDS,[3] depression and HIV/AIDS[4], childhood sexual abuse and HIV/AIDS[5], and violence and HIV/AIDS[6]. Our analysis extends this literature to show that the connection among these epidemic health problems and HIV/AIDS is far more complex than a 1-to-1 relationship; rather it is the additive interplay of these health problems that magnifies the vulnerability of a population to serious health conditions such as HIV/AIDS.[7]
In addition to the effects of depression, drug use, and a history of childhood abuse and/or violence on HIV infection rates, MSM are more likely to suffer from other psychological disorders, paraphilias,[8] and sexual addiction and compulsion.[9] They are far more likely to be diagnosed with any of an array of other sexually transmitted disease (STDs), some of which have become resistant to commonly used antibiotics[10], and some of which can make them more vulnerable to infection with HIV.[11] They are more likely than other men to engage in a wide variety of sexual practices which have the potential to spread STDs, to do so with a larger number of partners in venues which cater to multiple and anonymous sexual encounters. And in spite of the known risks, gay activists have consistently — and in many cases successfully — resisted proven public health strategies for the prevention of the transmission of STDs.[12]
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