Using Syndemics Theory to Investigate Risk and Protective Factors Associated with Condomless Sex Among Youth Living with HIV in 17 U.S. Cities
Identifying risk and protective factors associated with condomless sex among youth living with HIV is imperative for developing effective HIV prevention strategies. A cross sectional sample of 1728 participants, 12 26 years of age, recruited from adolescent medicine clinics in 17 U.S. cities completed an audio computer assisted self interview with questions about their substance use, psychosocial factors, and attitudinal and behavioral factors. Guided by syndemics theory, a path analysis was used to assess the interrelations of these factors. Analyses of model fit statistics indicated statistically significant direct pathways between substance use, psychosocial factors, self efficacy for risk reduction, alternative risk reduction attitudes and behaviors and condomless sex. The total indirect effect of self efficacy for risk reduction on condomless sex through alternative risk reduction attitudes and behaviors was also significant. Multi faceted, tailored interventions that address individual risk and protective factors and their combined synergistic effects are urgently needed to prevent condomless sex among this population.ResumenIdentificar factores protectores y de riesgo asociados con el sexo sin condon entre jovenes con VIH es esencial para la prevencion. Se realizo un estudio de corte transversal con una muestra de 1728 participantes, de 12 a 26 anos de edad, en clinicas de adolescentes en 17 ciudades de los Estados Unidos, quienes fueron auto administrado una entrevista asistida por computadora y audio sobre el consumo de sustancias, factores psicosociales y de actitud y comportamiento. Analisis de trayectoria guiado por la teoria sindemia evaluo las interrelaciones de estos factores. Las estadisticas de ajuste de modelo indicaron vias directas estadisticamente significativas entre el consumo de sustancias, factores psicosociales, autoeficacia para reducir riesgo, actitudes y comportamientos de riesgo alternativos, y sexo sin condon. Tambien fue significativo el efecto total indirecto de autoeficacia sobre el sexo sin condon mediante actitudes y comportamientos de riesgo alternativos. Para prevenir el sexo sin condon entre jovenes son urgentes intervenciones adaptadas de multiples facetas dirigidas a factores protectores y de riesgo individual y a sus efectos sinergicos.
AIDS and Behavior