{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T17:30:42Z","timestamp":1790962242164,"version":"4.1.0"},"reference-count":44,"publisher":"Wiley","issue":"S4","license":[{"start":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T00:00:00Z","timestamp":1698796800000},"content-version":"vor","delay-in-days":31,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100003804","name":"Elizabeth Glaser Pediatric AIDS Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100003804","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001322","name":"South African Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001322","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006084","name":"Office of AIDS Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006084","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Several HIV\u2010related syndemics have been described among adults. We investigated syndemic vulnerability to hazardous drinking (HD), intimate partner violence (IPV) and household food insecurity (HFIS) in breastfed children born without HIV in urban South Africa. We compared those who were perinatally HIV exposed (CHEU) to those who were not (CHU), under conditions of universal maternal antiretroviral therapy (ART) and breastfeeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A prospective cohort of pregnant women living with HIV (WLHIV), and without HIV, were enrolled and followed with their infants for 12 months postpartum (2013\u20132017). All WLHIV initiated antenatal efavirenz\u2010based ART. Measurements of growth (\u223c3 monthly), infectious cause hospitalisation, ambulatory childhood illness (2\u2010week recall) and neurodevelopment (BSID\u2010III, measured at \u223c12 months\u2019 age) were compared across bio\u2010social strata using generalised linear regression models, with interaction terms; maternal data included interview\u2010based measures for HD (AUDIT\u2010C), IPV (WHO VAW) and HFIS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 872 breastfeeding mother\u2010infant pairs (<jats:italic>n<\/jats:italic> = 461 CHEU, <jats:italic>n<\/jats:italic> = 411 CHU), WLHIV (vs. HIV negative) reported more unemployment (279\/461, 60% vs. 217\/411, 53%; <jats:italic>p<\/jats:italic> = 0.02), incomplete secondary education (347\/461, 75% vs. 227\/411, 55%; <jats:italic>p<\/jats:italic> &lt; 0.0001), HD (25%, 117\/459 vs. 7%, 30\/411; <jats:italic>p<\/jats:italic> &lt; 0.0001) and IPV (22%, 101\/457 vs. 8%, 32\/411; <jats:italic>p<\/jats:italic> &lt; 0.0001) at enrolment; and HFIS at 12 months (45%, 172\/386 vs. 30%, 105\/352; <jats:italic>p<\/jats:italic> &gt;\u00a00.0001). There were positive interactions between maternal HIV and other characteristics. Compared to food secure CHU, the mean difference (95% CI) in weight\u2010for\u2010age Z\u2010score (WAZ) was 0.06 (\u22120.14; 0.25) for food insecure CHU; \u22120.26 (\u22120.42; \u22120.10) for food secure CHEU; and \u22120.43 (\u22120.61; \u22120.25), for food insecure CHEU. Results were similar for underweight (WAZ &lt; \u22122), infectious\u2010cause hospitalisation, cognitive and motor delay. HIV\u2010IPV interactions were evident for ambulatory diarrhoea and motor delay. There were HIV\u2010HD interactions for odds of underweight, stunting, cognitive and motor delay. Compared to HD\u2010unexposed CHU, the odds ratios (95% CI) of underweight were 2.31 (1.11; 4.82) for HD\u2010exposed CHU; 3.57 (0.84; 15.13) for HD\u2010unexposed CHEU and 6.01 (2.22; 16.22) for HD\u2010exposed CHEU.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These data suggest that maternal HIV\u2010related syndemics may partly drive excess CHEU health risks, highlighting an urgent need for holistic maternal and family care and support alongside ART to optimise the health of CHEU.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26152","type":"journal-article","created":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T08:51:29Z","timestamp":1698828689000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Children of a syndemic: co\u2010occurring and mutually reinforcing adverse child health exposures in a prospective cohort of HIV\u2010affected mother\u2010infant dyads in Cape Town, South Africa"],"prefix":"10.1002","volume":"26","author":[{"given":"Stanzi M.","family":"le Roux","sequence":"first","affiliation":[{"name":"Division of Epidemiology &amp; Biostatistics School of Public Health, University of Cape Town Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine J.","family":"Abrams","sequence":"additional","affiliation":[{"name":"Mailman School of Public Health ICAP at Columbia University, Columbia University  New York New York USA"},{"name":"Department of Pediatrics, Vagelos College of Physicians &amp; Surgeons Columbia University  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Zerbe","sequence":"additional","affiliation":[{"name":"Mailman School of Public Health ICAP at Columbia University, Columbia University  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamsin K.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Division of Epidemiology &amp; Biostatistics School of Public Health, University of Cape Town Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Landon","family":"Myer","sequence":"additional","affiliation":[{"name":"Division of Epidemiology &amp; Biostatistics School of Public Health, University of Cape Town Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,11]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"UNAIDS. 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