Evidence map›Paper›PMID 29615297›Full record

ArticleSocial science & medicine (1982)2018

Is there synergy in syndemics? Psychosocial conditions and sexual risk among men who have sex with men in India.

Cecilia Tomori, Allison M McFall, Sunil S Solomon, Aylur K Srikrishnan, Santhanam Anand, P Balakrishnan, Shruti H Mehta, David D Celentano

Abstract read
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In one paragraph

Article in Social science & medicine (1982), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
34citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

34 citing papers in PubMed, 1 synthesis or guideline pooled it.

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  20. Syndemic theory, methods, and data.Social science & medicine (1982) · 2022
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Cecilia TomoriDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States. Electronic address: cecilia.tomori@durham.ac.uk.
Allison M McFallDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States.
Sunil S SolomonDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States; Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, United States; YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India.
Aylur K SrikrishnanYR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India.
Santhanam AnandYR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India.
P BalakrishnanYR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India.
Shruti H MehtaDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States.
David D CelentanoDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States; Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, United States.

Funding

Vaccine Response and Immunotherapeutics SWGP30AI094189 · NIAID · JOHNS HOPKINS UNIVERSITY · PI Richard E. Chaisson · 2012 to 2026
$67.0M
Johns Hopkins HIV Epidemiology and Prevention Sciences Training ProgramT32AI102623 · NIAID · JOHNS HOPKINS UNIVERSITY · PI Shruti H Mehta · 2013 to 2026
$5.3M
Preventing HIV Infection Among MSM in Southern IndiaR01MH089266 · NIMH · JOHNS HOPKINS UNIVERSITY · PI CELENTANO, DAVID D. · 2010 to 2015
$2.9M
Improving HIV testing among wives of MSM in IndiaR21MH101059 · NIMH · JOHNS HOPKINS UNIVERSITY · PI SOLOMON, SUNIL SUHAS · 2013 to 2014
$396k
Investigating the Potential of Respondent-Driven Sampling to Reach Undiagnosed, Out-of-Care HIV-infected People Who Inject DrugsF31DA044046 · NIDA · JOHNS HOPKINS UNIVERSITY · PI MCFALL, ALLISON MARIE · 2017 to 2018
$78k
NIAID NIH HHS P30 AI094189NIAID NIH HHS T32 AI102623NIDA NIH HHS F31 DA044046NIMH NIH HHS R01 MH089266NIMH NIH HHS R21 MH101059
6 · The paper itself

Abstract

Syndemic theory describes the clustering and synergistic interaction of disease driven by contextual and social factors, which worsen health outcomes for a population, and has been applied to men who have sex with men (MSM) and their risk for HIV and other sexually transmitted infections. Recent reviews, however, have critiqued prevailing approaches in syndemic studies that assess only additive associations without evaluation of synergy. Following these suggestions, we compared the traditional additive approach with a test for synergistic association of 5 syndemic conditions (alcohol dependence, illicit drug use, depression, intimate partner violence (IPV), and childhood sexual abuse (CSA)) with unprotected anal intercourse (UAI) and active syphilis infection among 11,771 MSM recruited through respondent driven sampling from 12 cities in India. UAI was assessed via self-report and active syphilis infection was diagnosed by RPR and THPA tests. An additive association was explored using a condition count (range 0-5), and synergy was tested using relative excess risk due to interactions (RERIs) calculated from all 2-way and common 3-way interactions between conditions in adjusted regression models. There was a significant dose response associated with the syndemic count and UAI, and a similar pattern for syphilis, though not statistically significant. RERIs showed synergy for only one pair of conditions for UAI and syphilis, respectively: IPV + depression and alcohol dependence + illicit drug use. In this study, we found an additive association between syndemic conditions and UAI with evidence of synergistic interaction between a pair of psychosocial conditions, and no significant additive association, but a synergistic interaction between another pair of psychosocial conditions for syphilis. Our results lend further support to a critical reassessment of syndemic analyses. Closer attention to the cumulative development, underlying causal pathways, and possible synergistic interaction of co-occurring epidemics through combined qualitative and quantitative methodologies may yield more effective interventions for vulnerable, marginalized populations.

Indexed as

EpidemicsRisk-TakingSocial EnvironmentAdultAdult Survivors of Child AbuseAlcoholismComorbidityDepressionHomosexuality, MaleHumansIndiaIntimate Partner ViolenceMaleRisk FactorsSexual BehaviorSocial TheoryHIVIndiaMen who have sex with menPsychosocial factorsSyndemic theorySyphilisUnprotected anal intercourse

Identifiers

PMID29615297
PMCPMC5955386

What OpenQuestion holds

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Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.