Using a Syndemics Framework to Understand How Substance Use Contributes to Morbidity and Mortality among People Living with HIV in Africa: A Call to Action

Emmanuel Peprah, Bronwyn Myers, Andre-Pascal Kengne, Nasheeta Peer, Omar El-Shahawy, Temitope Ojo, Barbara Mukasa, Oliver Ezechi, Juliet Iwelunmor, Nessa Ryan, Fatoumata Sakho, John Patena and Joyce Gyamfi
Additional contact information
Emmanuel Peprah: Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA
Bronwyn Myers: Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia
Andre-Pascal Kengne: Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
Nasheeta Peer: Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
Omar El-Shahawy: Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA
Temitope Ojo: Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA
Barbara Mukasa: Mildmay Uganda, Kampala P.O. Box 24985, Uganda
Oliver Ezechi: Nigerian Institute of Medical Research, Yaba, Lagos 101245, Nigeria
Juliet Iwelunmor: College for Public Health and Social Justice, Department of Behavioral Science and Health Education, Saint Louis University, St. Louis, MO 63104, USA
Nessa Ryan: Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA
Fatoumata Sakho: Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA
John Patena: Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA
Joyce Gyamfi: Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA

IJERPH, 2022, vol. 19, issue 3, 1-12

Abstract: Substance use is increasing throughout Africa, with the prevalence of alcohol, tobacco, cannabis, and other substance use varying regionally. Concurrently, sub-Saharan Africa bears the world’s largest HIV burden, with 71% of people living with HIV (PWH) living in Africa. Problematic alcohol, tobacco, and other substance use among PWH is associated with multiple vulnerabilities comprising complex behavioral, physiological, and psychological pathways that include high-risk behaviors (e.g., sexual risk-taking), HIV disease progression, and mental health problems, all of which contribute to nonadherence to antiretroviral therapy. Physiologically, severe substance use disorders are associated with increased levels of biological markers of inflammation; these, in turn, are linked to increased mortality among PWH. The biological mechanisms that underlie the increased risk of substance use among PWH remain unclear. Moreover, the biobehavioral mechanisms by which substance use contributes to adverse health outcomes are understudied in low- and middle-income countries (LMIC). Syndemic approaches to understanding the co-occurrence of substance use and HIV have largely been limited to high-income countries. We propose a syndemic coupling conceptual model to disentangle substance use from vulnerabilities to elucidate underlying disease risk for PWH. This interventionist perspective enables assessment of biobehavioral mechanisms and identifies malleable targets of intervention.

Keywords: substance use; people living with HIV (PWH); Africa; syndemics (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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