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Given growing inequities, this study used complex systems theory, a scientific approach to understanding the interconnected parts, to identify and visualise the system of factors that shape the emergence or (re)production of HIV risk among GBMSM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A meta-synthesis of systematic reviews and meta-analyses was conducted to examine risk factors for HIV in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria and quality assessments using A Measurement Tool to Assess Systematic Reviews 2. After screening 255 studies, data were synthesised and visualised from 29 articles with moderate-quality or high-quality assessments. Study characteristics and risk factors for HIV were extracted, and data were thematically analysed into higher-order themes and respective subthemes aligned with Bronfenbrenner\u2019s socio-ecological model. Kumu.io, a system mapping software, was used to visualise the system of factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our thematic analysis and visualisation portray a dynamic and complex web of HIV risk that GBMSM experience implicated across all levels of the socio-ecological model: individual, interpersonal, community, institutional\/organisational and structural\/policy levels. These risk factors, in tandem, interact with one another to create pathways and patterns that generate feedback loops, such that the systems of factors create the emergence of GBMSM\u2019s HIV risk beyond that accounted for at the individual level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>GBMSM\u2019s HIV risk is socially patterned by a diversity of multilevel and interacting risk factors, which creates a dynamic and reinforcing system of HIV risk that requires attention in its totality to fully address HIV risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jech-2025-224002","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T18:20:16Z","timestamp":1765304416000},"page":"267-276","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["A web of risk: multilevel factors and feedback loops (re)produce HIV \u2018risk\u2019 among gay, bisexual and other men who have sex with men \u2013 a global systematic review"],"prefix":"10.1136","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1239-5153","authenticated-orcid":false,"given":"Kristefer","family":"Stojanovski","sequence":"first","affiliation":[{"name":"Department of Social, Behavioral and Population Sciences, Tulane University Celia Scott Weatherhead School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen","family":"Ogarrio","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Tulane University Celia Scott Weatherhead School of Public Health & Tropical Medicine, New Orleans, Louisiana, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emina","family":"Kubat","sequence":"additional","affiliation":[{"name":"Usher Institute, The University of Edinburgh, Edinburgh, UK"},{"name":"McGill University, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth J","family":"King","sequence":"additional","affiliation":[{"name":"Department of Health Behavior and Health Equity, University of Michigan School of Public Health, Ann Arbor, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine P","family":"Theall","sequence":"additional","affiliation":[{"name":"Department of Social, Behavioral and Population Sciences, Tulane University Celia Scott Weatherhead School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA"},{"name":"Department of Epidemiology, Tulane University Celia Scott Weatherhead School of Public Health & Tropical Medicine, New Orleans, Louisiana, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arline T","family":"Geronimus","sequence":"additional","affiliation":[{"name":"Department of Health Behavior and Health Equity, University of Michigan School of Public Health, Ann Arbor, Michigan, USA"},{"name":"University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,9]]},"reference":[{"key":"2026031002150956000_80.4.267.1","unstructured":"Global HIV & AIDS statistics \u2014 fact sheet. 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