COVID-19 and the Syndemic of Intimate Partner Violence, Mental Health, Substance Use, and HIV Care Engagement Among Black Sexual Minority Men Living with HIV in the US South

Carrie L. Nacht (), Hannah E. Reynolds, Chadwick K. Campbell, Kirstin Kielhold, Wilson Vincent, Daniel E. Siconolfi, Susan M. Kegeles and Erik D. Storholm
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Carrie L. Nacht: School of Public Health, San Diego State University, San Diego, CA 92182, USA
Hannah E. Reynolds: School of Public Health, San Diego State University, San Diego, CA 92182, USA
Chadwick K. Campbell: Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA 92093, USA
Kirstin Kielhold: School of Public Health, San Diego State University, San Diego, CA 92182, USA
Wilson Vincent: Department of Psychology and Neuroscience, Temple University, Philadelphia, PA 19122, USA
Daniel E. Siconolfi: RAND Corporation, Santa Monica, CA 90401, USA
Susan M. Kegeles: Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA 94158, USA
Erik D. Storholm: School of Public Health, San Diego State University, San Diego, CA 92182, USA

IJERPH, 2025, vol. 22, issue 7, 1-13

Abstract: Background: Black sexual minority men (BSMM) are disproportionately affected by HIV incidence and have lower rates of HIV care engagement (e.g., retention in care, viral suppression), particularly in the US South. The COVID-19 pandemic exacerbated co-occurring psychosocial syndemic factors (e.g., depression, violence, substance use) that disproportionately impact BSMM living with HIV (BSMM+), but the impact of the pandemic on HIV care engagement among BSMM+ in the US South has not been explored in depth. Methods: BSMM+ (n = 27) were recruited from a longitudinal cohort in Dallas and Houston, Texas. Participants with less-than-optimal HIV care engagement, previous experiences of intimate partner violence (IPV), and prevalence of self-reported substance use were purposively selected for in-depth interviews from June 2022 to August 2023. Interviews lasted 54 min on average and were audio-recorded, transcribed, and de-identified before applying a thematic analysis approach. Results: Over half of participants experienced a relationship with IPV, used illicit substances in the past 60 days, and were depressed. Interviews highlighted that, during the COVID-19 pandemic, heightened levels of depression, substance use, and IPV individually and synergistically inhibited ART adherence and HIV care engagement. Participants described how IPV served to worsen their mental health and substance use, which, in turn, were the core drivers of poor HIV care engagement. Conclusions: The findings suggest that the COVID-19 pandemic exacerbated the syndemics of IPV, mental health, and substance use, and these acted as barriers to HIV care engagement. Future adherence interventions should synergistically address syndemic factors to maximize effectiveness.

Keywords: sexual minority men; COVID-19; syndemics; HIV care engagement (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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