Syndemic Conditions and HIV Risk Behaviors among Young Adults in the United States

Introduction: The prevalence of HIV/AIDS remains a significant health concern, particularly among young adults in the US. The Syndemic Framework provides a lens through which to understand the complex interactions between health and social conditions with HIV risk behaviors. This study aims to identify syndemic classes and explore their associations with HIV risk behaviors. Methods: Utilizing secondary data from the 2019 national Youth Risk Behavior Surveillance System, this study focused on young adults aged 18 and above. The outcome variable, HIV risk behaviors, was operationalized as having multiple sex partners or engaging in condomless sex. Six syndemic conditions were assessed, encompassing depressive symptoms, binge drinking, marijuana use, experiences of sexual violence, dating violence, and bullying. Latent class analysis and logistic regression were used for data analysis. Results: A five-class model was identified through latent class analysis, including the Complex Syndemic class, the Violence Exposure Syndemic class, the Substance Use Syndemic class, the Depressive Syndemic class, and the No Syndemic class. Syndemic classes varied across sexes, sexual orientations, and races. Respondents in the Complex Syndemic class and the Substance Use Syndemic class were more likely to report HIV risk behaviors than those in other classes. The associations between syndemic classes and HIV risk behaviors did not differ by sex or sexual orientation. Conclusion: Findings of this dissertation supported the unequal contribution of syndemic conditions to HIV risk behaviors. Substance use, particularly binge drinking and marijuana use, significantly influenced HIV risk behaviors among young adults. Comprehensive strategies addressing substance use alongside HIV risk are essential for effective prevention efforts and overall well-being.