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An Application of Syndemic Theory to Identify Drivers of the Syphilis Epidemic Among Gay, Bisexual, and Other Men Who Have Sex With Men

Ferlatte, Olivier, PhD*; Salway, Travis, PhD†‡; Samji, Hasina, PhD†§; Dove, Naomi, MD†‡; Gesink, Dionne, PhD§; Gilbert, Mark, MD†¶; Oliffe, John, L., PhD*; Grennan, Troy, MD†∥; Wong, Jason, MD†¶

Sexually Transmitted Diseases: March 2018 - Volume 45 - Issue 3 - p 163–168
doi: 10.1097/OLQ.0000000000000713
Original Studies

Background We applied syndemic theory to explore the degree to which syndemic conditions explain the syphilis epidemic affecting Canadian gay and bisexual men who have sex with men (GBMSM).

Methods Data from a national survey comprising 7872 GBMSM were analyzed using multivariable logistic regression to measure associations between recent syphilis diagnosis (RSD; in previous 12 months) and the following variables: (1) sociodemographic information (sexuality, HIV status, age, income, ethnicity, relationship status), (2) antigay stigma (bullying, physical violence, sexual violence, career discrimination, health care discrimination), (3) syndemic conditions (suicidality, intimate partner violence, depression, illicit substance use, binge drinking), (4) sexual behaviors, (5) health care discrimination, and (6) the cumulative count of antigay experiences and syndemic conditions.

Results Three percent (n = 235) of GBMSM surveyed reported an RSD. Men were more likely to report an RSD if they were HIV positive (adjusted odds ratio [AOR], 6.27; 95% confidence interval [CI], 4.66–8.43). Recent syphilis diagnosis was also positively associated with career discrimination, health care discrimination, substance use, and intimate partner violence. Furthermore, prevalence of RSD increased with each additional form of stigma or syndemic condition. The odds of reporting RSD was 5.2 (95% CI, 1.0–25.9) times higher for men who reported experiencing all 4 forms of antigay stigma compared with those who reported no stigma, after adjusting for sociodemographics. Similarly, the adjusted odds of reporting RSD was 12.2 (95% CI, 2.0%–74.8%) times higher for GBMSM experiencing 5 syndemic conditions compared with those reporting no syndemic conditions.

Conclusions Evidence from this large cross-sectional study suggests that the Canadian syphilis epidemic among GBMSM is being driven by a syndemic constituted by multiple social and psychological conditions. Interventions addressing specific psychosocial health outcomes that increase the risk for syphilis should be developed and integrated within targeted sexual health services and syphilis prevention initiatives.

This study used syndemic theory to investigate associations between sexual stigma, syndemic conditions, and recent syphilis diagnoses among Canadian gay, bisexual, and other men who have sex with men.

From the *Men's Health Research Program, School of Nursing, University of British Columbia; †British Columbia Centre for Disease Control; ‡School of Population and Public Health, University of British Columbia, Vancouver; §Faculty of Health Sciences, Simon Fraser University, Burnaby; ¶Department of Medicine, University of British Columbia, Vancouver, British Columbia; ∥Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

The authors have no conflict of interest to declare.

The Sex Now survey was supported by a grant from the Vancouver Foundation. Additional financial support for this study was provided by the British Columbia Centre for Disease Control.

Correspondence: Olivier Ferlatte, PhD, Medical Sciences Block C Room 107, 2176 Health Sciences Mall, Vancouver, BC, Canada V6T 1Z3. E-mail: olivier.ferlatte@ubc.ca.

Received for publication June 26, 2017, and accepted August 20, 2017.

© Copyright 2018 American Sexually Transmitted Diseases Association