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J Acquir Immune Defic Syndr. 2018 Aug 1;78(4):376-382. doi: 10.1097/QAI.0000000000001697.

Validating the Syndemic Threat Surrounding Sexual Minority Men's Health in a Population-Based Study With National Registry Linkage and a Heterosexual Comparison.

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Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.



Research on the syndemic health threats facing sexual minority men suggests that the elevated risk of HIV among this population co-occurs with other psychosocial health disparities. This study aimed to conduct a population-based examination of clinically assessed syndemic predictors of HIV infection among gay and bisexual, compared with heterosexual, men.


The sample comprised adult men in the Stockholm Public Health Cohort. A total of 29,328 (91.9%) self-identified as heterosexual, 535 (1.7%) as gay, and 396 (1.2%) as bisexual. We linked survey responses to national health registry data.


Gay men had vastly elevated risk of HIV infection (>150 times) compared with heterosexuals. Gay men also had an elevated risk of depression, suicidality, and violent assaults compared with heterosexuals. Bisexual men had 16 times higher risk of being HIV-positive than heterosexual men. The number of psychosocial syndemic conditions was significantly associated with HIV infection among gay men (adjusted odds ratio [AOR] = 1.67; 95% confidence interval [95% CI]: 1.18 to 2.36), but not among bisexual and heterosexual men (AOR = 0.51; 95% CI: 0.07 to 3.59; AOR = 1.92; 95% CI: 0.96 to 3.84). Among gay men, the association between co-occurring syndemic conditions and odds of HIV infection was synergistic (ie, more than additive).


This study confirms emerging evidence of the syndemic health threats affecting sexual minority men, finds stronger evidence for syndemics among gay compared with bisexual men, and suggests the need for HIV-prevention interventions that comprehensively address the co-occurring, and synergistically perpetuating, disparities affecting this population.

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