{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T23:02:48Z","timestamp":1782255768952,"version":"3.54.5"},"reference-count":37,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T00:00:00Z","timestamp":1653004800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01HD077891"],"award-info":[{"award-number":["R01HD077891"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017035","name":"Johns Hopkins Center for AIDS Research","doi-asserted-by":"crossref","award":["#1P30AI094189"],"award-info":[{"award-number":["#1P30AI094189"]}],"id":[{"id":"10.13039\/100017035","id-type":"DOI","asserted-by":"crossref"}]},{"name":"San Diego Center for AIDS Research","award":["#P30AI036214"],"award-info":[{"award-number":["#P30AI036214"]}]},{"DOI":"10.13039\/100000027","name":"National Institute of Alcohol Abuse and Alcoholism","doi-asserted-by":"crossref","award":["K01AA025009-K"],"award-info":[{"award-number":["K01AA025009-K"]}],"id":[{"id":"10.13039\/100000027","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["L60MD003701"],"award-info":[{"award-number":["L60MD003701"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["L60MD011184-K"],"award-info":[{"award-number":["L60MD011184-K"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:p><jats:bold>Objectives<\/jats:bold>Black women disproportionately experience STIs (including HIV\/AIDS), gender-based violence, substance misuse and mental health conditions. Addressing a gap in syndemic research, we characterised comorbidity overlap within the context of sociostructural inequities and adverse childhood experiences (ACEs) among black women in Baltimore, Maryland.<\/jats:p><jats:p><jats:bold>Methods<\/jats:bold>Between 2015 and 2018, black women (n=305) were recruited from STI clinics in Baltimore, Maryland. Among those with complete survey data (n=230), we conducted a latent class analysis to differentiate women based on their profile of the following syndemic comorbidities: STIs, adult sexual victimisation, substance misuse and mental health disorders. We then examined the association between ACEs and syndemic latent class membership.<\/jats:p><jats:p><jats:bold>Results<\/jats:bold>Thirty-three percent of women experienced three to nine ACEs before age 18 years, and 44% reported four to six comorbidities. The two-class latent class solution demonstrated the best fit model, and women were categorised in either class 1 (past-year STI; 59%) or class 2 (syndemic comorbidities; 41%). Women in class 2 were more likely to report unstable housing (10% vs 3%) and identify as bisexual\/gay (22% vs 10%) than women in class 1. ACEs were significantly associated with an increased likelihood of class 2 membership.<\/jats:p><jats:p><jats:bold>Conclusions<\/jats:bold>This study reinforces the importance of screening for ACEs and offering trauma-informed, integrated care for black women with syndemic comorbidities. It also highlights the critical nature of tailoring interventions to improve sociostructural equity, preventing and reducing syndemic development.<\/jats:p>","DOI":"10.1136\/sextrans-2021-055224","type":"journal-article","created":{"date-parts":[[2022,5,23]],"date-time":"2022-05-23T17:56:17Z","timestamp":1653328577000},"page":"7-13","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Characterising a syndemic among black women at risk for HIV: the role of sociostructural inequity and adverse childhood experiences"],"prefix":"10.1136","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9141-1395","authenticated-orcid":false,"given":"Kiyomi","family":"Tsuyuki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Chan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marguerite B","family":"Lucea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Cimino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abby E","family":"Rudolph","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yordanos","family":"Tesfai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacquelyn C","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina J","family":"Catabay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1909-6965","authenticated-orcid":false,"given":"Jamila K","family":"Stockman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,5,20]]},"reference":[{"key":"2023101000001316000_99.1.7.1","unstructured":"Centers for Disease Control and Prevention . 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Substance use disorders, violence, mental health, and HIV: differentiating a syndemic factor by gender and sexuality 2017;21:2270\u201382.","DOI":"10.1007\/s10461-017-1841-3"},{"key":"2023101000001316000_99.1.7.15","doi-asserted-by":"crossref","unstructured":"Elder GH , Johnson MK , Crosnoe R . The emergence and development of life course theory. In: Handbook of the life course. 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