{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T10:16:28Z","timestamp":1789208188492,"version":"build-2803163510"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,2,3]],"date-time":"2020-02-03T00:00:00Z","timestamp":1580688000000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Drug and Alcohol Review"],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction and Aims<\/jats:title><jats:p>Past research investigating syndemic factors and HIV\u2010related outcomes has overlooked the impact of structural conditions on behaviours linked with HIV transmission and disease progression. Given prevalent substance use among our sample, we explored whether four structural conditions indicative of social marginalisation and previously correlated with increased risk for HIV infection demonstrated syndemic (additive\/synergistic) effects on: (i) HIV viral suppression; and (ii) self\u2010reported involvement in sexual HIV transmission behaviours among a prospective cohort mostly comprising men of colour who have sex with men (MCSM; i.e. Latino\/Hispanic and African American\/black men) in Los Angeles County.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and Methods<\/jats:title><jats:p>Data were collected between August 2014 and March 2017. The structural conditions of interest were: current unemployment, recent (\u22646 months) incarceration history, \u2018unstable\u2019 accommodation (past month) and remote (&gt;6 months) contact with health\u2010care providers. Generalised estimating equations assessed possible additive effects of experiencing multiple structural conditions, and possible synergistic effects on the HIV\u2010related outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 428 participants, nearly half (49%) were HIV\u2010positive at baseline. Involvement in sexual HIV transmission risk behaviours varied over follow\u2010up (22\u201330%). Reporting \u22652 structural syndemic conditions was significantly associated with reporting sexual HIV transmission risk behaviours among HIV\u2010negative participants, and detectable viral load among HIV\u2010positive participants. Frequent methamphetamine use was consistently associated with the HIV\u2010related outcomes across the final multivariate models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and Conclusions<\/jats:title><jats:p>When developing initiatives to address HIV transmission among marginalised sub\u2010populations including MCSM, we must holistically consider systemic and structural issues (e.g. unemployment and homelessness), especially in the context of prevalent substance use.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dar.13026","type":"journal-article","created":{"date-parts":[[2020,2,3]],"date-time":"2020-02-03T18:37:31Z","timestamp":1580755051000},"page":"116-127","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Investigating possible syndemic relationships between structural and drug use factors, sexual HIV transmission and viral load among men of colour who have sex with men in Los Angeles County"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2977-3133","authenticated-orcid":false,"given":"Brendan","family":"Quinn","sequence":"first","affiliation":[{"name":"Center for Behavioural and Addiction Medicine, Department of Family Medicine University of California  Los Angeles USA"},{"name":"Behaviours and Health Risks and Disease Elimination Programs Burnet Institute  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamina M.","family":"Gorbach","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Fielding School of Public Health University of California  Los Angeles USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6080-4866","authenticated-orcid":false,"given":"Chukwuemeka N.","family":"Okafor","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine University of California  Los Angeles USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith G.","family":"Heinzerling","sequence":"additional","affiliation":[{"name":"Center for Behavioural and Addiction Medicine, Department of Family Medicine University of California  Los Angeles USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Shoptaw","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, David Geffen School of Medicine University of California  Los Angeles USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,2,3]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Division of HIV and STD Programs \u2010 Los Angeles County Department of Public Health. 2015 Annual HIV\/STD Surveillance Report.2017. 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