Co-occurring Psychosocial Problems and HIV Risk Among Women Attending Drinking Venues in a South African Township: A Syn
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ORIGINAL ARTICLE
Co-occurring Psychosocial Problems and HIV Risk Among Women Attending Drinking Venues in a South African Township: A Syndemic Approach Eileen V. Pitpitan, Ph.D. & Seth C. Kalichman, Ph.D. & Lisa A. Eaton, Ph.D. & Demetria Cain, M.P.H. & Kathleen J. Sikkema, Ph.D. & Melissa H. Watt, Ph.D. & Donald Skinner, Ph.D. & Desiree Pieterse, M.P.H. Published online: 3 October 2012 # The Society of Behavioral Medicine 2012
Abstract Background In South Africa, women comprise the majority of HIV infections. Syndemics, or co-occurring epidemics and risk factors, have been applied in understanding HIV risk among marginalized groups. Purpose The purposes of this study are to apply the syndemic framework to examine psychosocial problems that co-occur among women attending drinking venues in South Africa and to test how the co-occurrence of these problems may exacerbate risk for HIV infection. Method Five hundred sixty women from a Cape Town township provided data on multiple psychosocial problems, including food insufficiency, depression, abuse experiences, problem drinking, and sexual behaviors. Results Bivariate associations among the syndemic factors showed a high degree of co-occurrence and regression analyses showed an additive effect of psychosocial problems on HIV risk behaviors. Conclusions These results demonstrate the utility of a syndemic framework to understand co-occurring psychosocial problems among women in South Africa. HIV prevention
E. V. Pitpitan (*) : S. C. Kalichman : L. A. Eaton : D. Cain Center for Health, Intervention and Prevention, University of Connecticut, 2006 Hillside Rd, Unit 1248, Storrs, CT 06269-1020, USA e-mail: [email protected] K. J. Sikkema : M. H. Watt Duke University, Durham, NC, USA D. Skinner : D. Pieterse Stellenbosch University, Cape Town, South Africa
interventions should consider the compounding effects of psychosocial problems among women. Keywords HIV risk . Sexual risk behavior . Syndemics . Mental health . Abuse . Alcohol
Introduction More than any country in the world, South Africa has the highest number of people living with HIV/AIDS, with an estimated 5.6 million people in 2009. In Cape Town, South Africa’s second largest city, HIV prevalence is 13 %, reaching as high as 25 % in the city’s impoverished urban townships and informal settlements [1]. Women comprise the majority of HIV infections in this country [2], making it imperative to examine the factors that contribute to women’s HIV risk behavior, particularly in high-risk, impoverished areas. South Africa is a resource poor country, where substantial economic, social, and health disparities exist. Therefore, it would not be surprising to find that women in this country experience a great number of different psychosocial problems. In the past decade, researchers have identified the synergistic co-occurrence of multiple epidemics and risk factors that can develop in conditions of such disparities, a phenomenon known as a syndemic [3, 4]. In contrast to an epidemic, which characterizes an increasing
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