The Syndemic Factors of Violence Exposure, Substance Use, and Mental Health Problems: Relationships to Sexual Risk Behaviors in HIV-Negative Young Men Who Have Sex With Men.

Objective: A syndemic of violence exposure, substance misuse, and mental health problems (i.e., depression, anxiety, posttraumatic stress disorder) is associated with increased unprotected anal sex and number of sexual partners in young men who have sex with men (YMSM). However, few studies have examined multiple forms of violence-including childhood abuse, intimate partner violence, and community violence-and identified which factors are significant predictors of HIV risk for YMSM when controlling for all other factors. Accordingly, this study examined the additive and independent influence of different forms of violence, substance misuse, and mental health problems associated with sexual risk behaviors in YMSM who used HIV prevention services. Method: A convenience sample of 168 (97 Black or multiethnic Black, 71 white) YMSM ages 18-34 completed computer-assisted personal interviews assessing syndemic factors and HIV risk behaviors. We conducted Spearman correlations and negative binomial regressions to describe syndemic relationships and identify the significant independent predictors of HIV risk. Results: A syndemic of violence exposure, substance use, and mental health problems was observed in the sample. Also, participants with depression, drug abuse in the clinical range, and polydrug use reported significantly higher frequencies of sexual risk behaviors. Violence exposure did not uniquely predict sexual risk. Conclusions: Depression, drug abuse, and polydrug use should be targets for HIV prevention among YMSM using HIV prevention services.