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This study, conducted among men who have sex with men (MSM) in sub-Saharan Africa (SSA), sought to replicate the syndemic effects of psychosocial health problems on HIV risk by using data collected from a sample of 300 MSM and bisexuals from Tanzania. We also sought to test the utility of syndemic theory by replicating the effects of the number of syndemic conditions on HIV risk behavior in that population. Five psychosocial health problems (i.e., the syndemic factors), acronymized as SAVID, were examined: substance use while having condomless sexual intercourse, childhood and adolescent sexual abuse, experience of anti-gay violence, internalized homonegativity (IH), and depression. Nine of the 10 odds ratios (ORs) generated from analysis of the bivariate associations between these syndemic factors were found to be statistically significant and positive; the tenth was marginally significant and positive. These results indicate not only a high degree of coexistence of the syndemic factors but also suggest that possible interactions between these factors may have additive effects on the behavioral health outcomes of the study participants. Such additive effects were confirmed by finding a A¢Â€Âœdose-responseA¢Â€Â� relationship between HIV risk-associated sexual behavior and the number of the five syndemic factors reported by each participant. After controlling for demographic and contextual factors, we found that the SAVID syndemic variable significantly increased the odds of engaging in condomless sexual intercourse (OR, 1.48). This substantiates the central tenet of syndemic theory, which is that those participants who were exposed to a greater number of the psychosocial health problems also engaged in higher-risk sexual behavior. Multivariate regression analyses revealed not only the effect of two of the syndemic conditions (substance use during sex and IH) on HIV risk-related sexual behavior but also confirmed how one demographic variable (younger age) and one culturally structured factor (being gay but still having a meaningful sexual relationship with women) uniquely contributed to syndemic conditions among Tanzanian MSM. These results suggest that a multifaceted HIV intervention grounded in syndemic theory should be considered as an effective approach to mitigating the risk environment that potentiates the vulnerability to HIV among Tanzanian MSM.

Background: In the extremely homophobic conditions in Tanzania and other countries in sub-Saharan Africa (SSA), men who have sex with men (MSM) experience disproportionate amounts of both HIV infection and psychosocial health problems, but no research has been conducted to examine the synergistic or additive effects of these adversities on their experiences. While the predominantly deficit-based research approach has identified various HIV risks and vulnerabilities, any naturally occurring protective and resilience factors that these men naturally employ to these health-related adversities remain undetermined. Purpose: This study examined the syndemic effects of psychosocial health problems on HIV infection and HIV risk and simultaneously sought to identify any resilience or protective factors that may buffer against the syndemic production of HIV infection and risk behavior among high-risk Tanzanian MSM. These syndemic health problems were coined as SAVID (Substance abuse during condomless sex, childhood and adolescent sexual abuse, violence, internalized homonegativity and depression) Methods: Cross-sectional data on demographic characteristics and HIV prevalence and risks among Tanzanian MSM residing in Dar es Salaam and Tanga were used to examine whether there is a proportional increase in HIV infection and risk as the number of syndemic conditions increases. Logistic regression analysis was used to test for interactions between syndemic conditions and to identify any potential resilience factors as a way of establishing protection against the syndemic production of HIV infection and risk among these men. At the level of interaction between protective resilience factors (moderators)-support, age visibility- and SAVID syndemic; those that reported high social visibility among Acquaintance have lower odds of contracting HIV infection when compared to those that have lower social visibility among acquaintances Results: The results revealed significant additive associations between increasing numbers of SAVID syndemic components and higher rates of HIV infection and risk. Among a variety of identified potential resilience factors, three-functional socio-support, age at self-awareness of sexual orientation and formal social visibility among acquaintances-were found to directly associated with lower odds of contracting HIV infection. At the level of interaction between protective resilience factors (moderators: functional social support, age at awareness of sexual orientation, and formal social visibility among acquaintances) and SAVID syndemics, only those sampled MSM that reported high social visibility among acquaintances had lower odds of contracting HIV infection when compared to sampled MSM that had lower formal social visibility among acquaintances Conclusion: Harnessing naturally-occurring resilience factors through strength-based research approach and innovatively disseminate them through existing secrete social network may be a cost effective and a novel health promotion strategy suitable for MSM in extreme homophobic environment.

Tanzanian men who have sex with men (MSM) experience HIV disparity and are disproportionately vulnerable to psychosocial health problems together called SAVID (Substance abuse, childhood and adolescent sexual Abuse [CSA], anti-gay Violence, Internalized homonegativity [IH], and Depression). We applied syndemic theory to assess additive effects of the SAVID problems on HIV seropositivity among 300 MSM from two Tanzanian cities, who provided demographic, psychosocial health–problem, and HIV-status information. Prevalence rates of the problems were substance abuse during condomless sexual intercourse (37.3%), a history of CSA (35.3%), anti-gay violence (22%), high IH (52.7%), and depression (58%). Bivariate analysis showed a significantly positive “dose-response” relationship between the SAVID-problem count and HIV seropositivity: SAVID problems significantly increased the odds of HIV seropositivity (odds ratio, 1.42). This is the first study in sub-Saharan Africa to use syndemic theory to explore additive effects of coexisting psychosocial health problems on HIV seropositivity among Tanzanian MSM. Our results underscore the need for comprehensive HIV interventions targeting MSM.

Background: Parent-child sexual health communication is a well-documented protective factor against early sexual debut and other sexual risk behaviors. Yet, little is known about communication between single, African American mother-early adolescent son dyads. To address this, a mixed method, qualitative dominant, study design was used to explore the dynamics of sexual health communication between single African-American mothers and their early adolescent sons aged 11-14 years old. Methods: Mothers and sons, recruited from community health fairs and after-school programs, participated in separate in-depth semi-structured interviews to explore mother-son sexual health communication and sons completed a brief survey about sexual activity. Results: Mothers and sons expressed both comforts and discomforts with communication. Most mothers and sons reported high connectedness and felt comfortable talking with their sons about sex. Most sons agreed with the content of the sexual health message reported by their mothers, identified their mothers as approachable, and some sons reported that they would talk with their mothers before they started having sex. Mothers report providing a twoprong message to delay sexual debut and use condoms when sexually active and a strong desire to have their son disclose his intentions to sexually debut in order to facilitate sexual health decision-making and provide access to condoms. Findings from this study provide preliminary descriptive data that can be used by providers to facilitate parent-child sexual health communication during early adolescence and prior to a child's sexual debut.