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Member Research & Reports

Member Research & Reports

Brown: Using Syndemics Theory to Investigate Risk and Protective Factors with Condomless Sex among Youth Living with HIV in 17 U.S. Cities

An estimated 22% of all new HIV diagnoses are in adolescents and young adults between the ages of 13 and 24, and almost half of youth living with HIV do not know that they are infected. Multiple protective and risk factors have been identified as being associated with risky sex among adolescents, although these correlates have varied across past studies.

Jacob van den Berg, Assistnat Professor of Behavioral and Social Sciences (research)

[Photo: Dr. Jacob Vandenberg]

Syndemics theory posits that the synergistic interaction of multiple adverse conditions within populations produces a stronger overall health outcome than if each of the conditions were experienced separately. The purpose of this study, led by Dr. Jacob Vandenberg, Assistant Professor in the Department of Behavioral and Social Sciences at the School of Public Health and Director of the Brown University AIDS Program, was to apply syndemics theory to investigate the interrelations between factors contributing to condomless sex among youth.

This analysis drew from a sample of almost two thousand participants, from 12 to 26 years of age, across 17 cities in the United States. Factors to be evaluated included frequency of substance use, severity of substance use, emotional distress, social support, self-efficacy for risk reduction, and alternative risk-reduction attitudes and behaviors.

The researchers found that there were significant interrelationships between the factors evaluated. Alternative attitudes and behaviors and self-efficacy were found to be the proximal and distal mediators between frequency of substance use, severity of substance use, emotional distress and social support, and condomless anal and vaginal sex. Furthermore, substance use frequency and severity, emotional distress, self-efficacy, and alternative attitudes and behaviors were all directly related to condomless sex. Severity of substance abuse, emotional distress, and social support were also directly related to alternative attitudes and behaviors.

This study highlights the complex interactions between factors that contribute to an increased risk of condomless sex in youths. Multi-faceted, tailored interventions that address individual risk and protective factors and their combined synergistic effects are urgently needed to prevent condomless sex among this population.

This study was published in AIDS and Behavior, 2016.

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