{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:35:00Z","timestamp":1760060100857,"version":"build-2065373602"},"reference-count":51,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"U.S. Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["HHSD2002013M53964B"],"award-info":[{"award-number":["HHSD2002013M53964B"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Despite the increasing adoption of a syndemic approach in HIV research, few health communication campaigns have used a syndemic approach in messaging to improve health outcomes for persons living with HIV (PWH). This paper introduces a framework for practitioners and researchers developing health communication messages in support of a syndemic approach to HIV care for PWH in the United States. Grounded in insights from a review of counseling and psychosocial interventions that demonstrated significant positive effects on HIV clinical outcomes, the C4H Framework emphasizes four components: compassion, comprehensive messaging, capacity-building, and coordination. Compassion ensures that messages resonate with individuals experiencing the intertwined challenges of HIV, substance abuse, and mental health issues. Comprehensive messaging integrates a holistic view of the barriers faced by PWH. Capacity-building empowers individuals to effectively engage with and act upon health information. Coordination promotes alignment between stakeholders and resources to ensure consistent and supportive messaging. The C4H Framework bridges the gap between research and practice, offering a foundation for crafting effective communication messages that resonate with individuals facing the complex challenges inherent in HIV syndemics. Future research should explicitly test the effectiveness and acceptability of messages developed using the C4H Framework with people living with HIV.<\/jats:p>","DOI":"10.3390\/ijerph22081231","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T10:07:38Z","timestamp":1754561258000},"page":"1231","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comprehensive Communication for a Syndemic Approach to HIV Care: A Framework for Enhancing Health Communication Messages for People Living with HIV"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8247-4215","authenticated-orcid":false,"given":"Sarah E.","family":"Sheff","sequence":"first","affiliation":[{"name":"RTI International, Research Triangle Park, NC 27709, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa","family":"Boudewyns","sequence":"additional","affiliation":[{"name":"RTI International, Research Triangle Park, NC 27709, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jocelyn Coleman","family":"Taylor","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, GA 30329, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8317-2785","authenticated-orcid":false,"given":"Hannah","family":"Getachew-Smith","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, GA 30329, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nivedita L.","family":"Bhushan","sequence":"additional","affiliation":[{"name":"RTI International, Research Triangle Park, NC 27709, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5798-7721","authenticated-orcid":false,"given":"Jennifer D.","family":"Uhrig","sequence":"additional","affiliation":[{"name":"RTI International, Research Triangle Park, NC 27709, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1016\/0277-9536(94)90205-4","article-title":"Aids and the health crisis of the us urban poor; the perspective of critical medical anthropology","volume":"39","author":"Singer","year":"1994","journal-title":"Soc. Sci. Med."},{"key":"ref_2","first-page":"99","article-title":"A dose of drugs, a touch of violence, a case of AIDS: Conceptualizing the sava syndemic","volume":"24","author":"Singer","year":"1996","journal-title":"Free Inq. Creat. Sociol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/BF02879919","article-title":"Psychosocial health problems increase risk for HIV among urban young men who have sex with men: Preliminary evidence of a syndemic in need of attention","volume":"34","author":"Mustanski","year":"2007","journal-title":"Ann. Behav. Med."},{"key":"ref_4","unstructured":"Centers for Disease Control and Prevention (2025, May 25). Division of HIV Prevention Strategic Plan Supplement: An Overview of Refreshed Priorities for 2022\u20132025, Available online: https:\/\/www.cdc.gov\/nchhstp\/newsroom\/media\/pdfs\/cdc-hiv-dhap-external-strategic-plan-2022.pdf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/S0140-6736(17)30003-X","article-title":"Syndemics and the biosocial conception of health","volume":"389","author":"Singer","year":"2017","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.socscimed.2018.03.040","article-title":"Syndemics: A theory in search of data or data in search of a theory?","volume":"206","author":"Tsai","year":"2018","journal-title":"Soc. Sci. Med."},{"key":"ref_7","first-page":"e25259","article-title":"Addressing the HIV syndemic: A structural and environmental approach","volume":"21","author":"Willis","year":"2018","journal-title":"J. Int. AIDS Soc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S91","DOI":"10.1097\/QAI.0b013e3181fbc9ec","article-title":"Hiv in transgender communities: Syndemic dynamics and a need for multicomponent interventions","volume":"55","author":"Operario","year":"2010","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e574","DOI":"10.1016\/S2352-3018(22)00076-5","article-title":"Integrating HIV and mental health interventions to address a global syndemic among men who have sex with men","volume":"9","author":"Operario","year":"2022","journal-title":"Lancet HIV"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1080\/17441692.2020.1724317","article-title":"Whither syndemics?: Trends in syndemics research, a review 2015\u20132019","volume":"15","author":"Singer","year":"2020","journal-title":"Glob. Public Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"112817","DOI":"10.1016\/j.socscimed.2020.112817","article-title":"The impact of a syndemic theory-based intervention on HIV transmission risk behaviour among men who have sex with men in india: Pretest-posttest non-equivalent comparison group trial","volume":"295","author":"Chakrapani","year":"2022","journal-title":"Soc. Sci. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1177\/10497315221121807","article-title":"Intervening on the intersecting issues of intimate partner violence, substance use, and HIV: A review of social intervention group\u2019s (sig) syndemic-focused interventions for women","volume":"33","author":"Gilbert","year":"2023","journal-title":"Res. Soc. Work Pract."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1111\/j.1467-6494.2004.00295.x","article-title":"When the social self is threatened: Shame, physiology, and health","volume":"72","author":"Dickerson","year":"2004","journal-title":"J. Personal."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.cbpra.2019.03.001","article-title":"A novel technology-enhanced internalized stigma and shame intervention for HIV-positive persons with substance use disorders","volume":"27","author":"Batchelder","year":"2020","journal-title":"Cogn. Behav. Pract."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1007\/s10461-019-02702-6","article-title":"Effectiveness of an intervention for improving treatment adherence, service utilization and viral load among HIV-positive adult alcohol users","volume":"24","author":"Attonito","year":"2020","journal-title":"AIDS Behav."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e53","DOI":"10.1093\/hsw\/hlx013","article-title":"Addressing structural barriers to HIV care among triply diagnosed adults: Project bridge oakland","volume":"42","author":"Powers","year":"2017","journal-title":"Health Soc. Work"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1007\/s10461-023-04242-6","article-title":"Message framing strategies to promote the uptake of prep: Results from formative research with diverse adult populations in the united states","volume":"28","author":"Boudewyns","year":"2024","journal-title":"AIDS Behav."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1108\/JSOCM-08-2013-0051","article-title":"Bundling of stds and HIV in prevention messages","volume":"5","author":"Poehlman","year":"2015","journal-title":"J. Soc. Mark."},{"key":"ref_19","unstructured":"Chicago Department of Public Health (2025, May 05). HIV-STI Data Report, Available online: https:\/\/www.chicago.gov\/content\/dam\/city\/depts\/cdph\/HIV_STI\/CDPH_HIVSTI_DataReport_09-2022.pdf."},{"key":"ref_20","unstructured":"Daskalakis, D., and Phillips, H.J. (2024, August 11). Addressing Monkeypox Holistically, Available online: https:\/\/web.archive.org\/web\/20240811023646\/https:\/\/www.hiv.gov\/blog\/addressing-monkeypox-holistically\/."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2674","DOI":"10.1007\/s10461-018-2086-5","article-title":"Testing the efficacy of combined motivational interviewing and cognitive behavioral skills training to reduce methamphetamine use and improve HIV medication adherence among HIV-positive gay and bisexual men","volume":"22","author":"Parsons","year":"2018","journal-title":"AIDS Behav."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1007\/s11524-014-9870-y","article-title":"Community-based harm reduction substance abuse treatment with methamphetamine-using men who have sex with men","volume":"91","author":"Carrico","year":"2014","journal-title":"J. Urban Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1007\/s10461-013-0606-x","article-title":"Increasing quality of life and reducing HIV burden: The path+ intervention","volume":"18","author":"Blank","year":"2014","journal-title":"AIDS Behav."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/QAI.0000000000000803","article-title":"Effective treatment of depressive disorders in medical clinics for adolescents and young adults living with HIV: A controlled trial","volume":"71","author":"Brown","year":"2016","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2756","DOI":"10.1007\/s10461-013-0465-5","article-title":"Telephone based cognitive behavioral therapy targeting major depression among urban dwelling, low income people living with HIV\/AIDS: Results of a randomized controlled trial","volume":"17","author":"Himelhoch","year":"2013","journal-title":"AIDS Behav."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2816","DOI":"10.1007\/s10461-013-0538-5","article-title":"A preliminary rct of cbt-ad for adherence and depression among HIV-positive latinos on the U.S.-Mexico border: The nuevo d\u00eda study","volume":"17","author":"Simoni","year":"2013","journal-title":"AIDS Behav."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s13643-020-01523-2","article-title":"Theories of change for e-health interventions targeting HIV\/STIs and sexual risk, substance use and mental ill health amongst men who have sex with men: Systematic review and synthesis","volume":"10","author":"Meiksin","year":"2021","journal-title":"Syst. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1080\/08964289.2019.1570074","article-title":"A framework for using ehealth interventions to overcome medical mistrust among sexual minority men of color living with chronic conditions","volume":"45","author":"Ramos","year":"2019","journal-title":"Behav. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"29","DOI":"10.21037\/mhealth-22-33","article-title":"Virtual avatars as a new tool for human immunodeficiency virus prevention among men who have sex with men: A narrative review","volume":"9","author":"Portillo","year":"2023","journal-title":"Mhealth"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1080\/09540121.2018.1446071","article-title":"Resilience as a moderator between syndemics and depression in mothers living with HIV","volume":"30","author":"Thurston","year":"2018","journal-title":"AIDS Care"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3658","DOI":"10.1007\/s10461-021-03292-y","article-title":"Resilience, anxiety, stress, and substance use patterns during COVID-19 pandemic in the miami adult studies on HIV (mash) cohort","volume":"25","author":"Tamargo","year":"2021","journal-title":"AIDS Behav."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.1080\/09540121.2018.1510106","article-title":"\u201dStay strong! Keep ya head up! Move on! It gets better!!!!\u201d: Resilience processes in the healthmpowerment online intervention of young black gay, bisexual and other men who have sex with men","volume":"30","author":"Barry","year":"2018","journal-title":"AIDS Care"},{"key":"ref_33","unstructured":"Connecticut Department of Public Health (2024, August 11). Ending the Syndemic. Available online: https:\/\/endthesyndemicct.org\/."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1080\/09540121.2016.1199846","article-title":"Organization of care for persons with HIV-infection: A systematic review","volume":"29","author":"Handford","year":"2017","journal-title":"AIDS Care"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"218","DOI":"10.3109\/10826084.2011.522840","article-title":"Strategies to improve access to and utilization of health care services and adherence to antiretroviral therapy among HIV-infected drug users","volume":"46","author":"Cunningham","year":"2011","journal-title":"Subst. Use Misuse"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2492","DOI":"10.1007\/s10461-024-04324-z","article-title":"Interventions for integrating behavioral health into HIV settings for us adults: A narrative review of systematic reviews and meta-analyses, 2010\u20132020","volume":"28","author":"McKinnon","year":"2024","journal-title":"AIDS Behav."},{"key":"ref_37","unstructured":"HIV.gov (2025, May 30). Find HIV Services near You, Available online: https:\/\/locator.hiv.gov\/."},{"key":"ref_38","unstructured":"Centers for Disease Control and Prevention (2024, October 23). Let\u2019s Stop HIV Together, Available online: https:\/\/www.cdc.gov\/stophivtogether\/index.html."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s10461-005-9000-7","article-title":"Housing status and HIV risk behaviors: Implications for prevention and policy","volume":"9","author":"Aidala","year":"2005","journal-title":"AIDS Behav."},{"key":"ref_40","first-page":"1194","article-title":"Structural approaches to HIV prevention","volume":"388","author":"Mayer","year":"2016","journal-title":"Lancet"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Baral, S., Sifakis, F., Cleghorn, F., and Beyrer, C. (2007). Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries 2000\u20132006: A systematic review. PLoS Med., 4.","DOI":"10.1371\/journal.pmed.0040339"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1007\/s10865-013-9536-3","article-title":"Food insecurity and antiretroviral adherence among HIV positive adults who drink alcohol","volume":"37","author":"Kalichman","year":"2014","journal-title":"J. Behav. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"4","DOI":"10.21037\/mhealth.2019.09.12","article-title":"Assessing mobile health feasibility and acceptability among HIV-infected cocaine users and their healthcare providers: Guidance for implementing an intervention","volume":"6","author":"Brown","year":"2020","journal-title":"Mhealth"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1080\/09540121.2011.582078","article-title":"Patient perspectives on tobacco cessation services for persons living with HIV\/AIDS","volume":"24","author":"Robinson","year":"2012","journal-title":"AIDS Care"},{"key":"ref_45","first-page":"977","article-title":"A systematic review of qualitative studies examining the experiences of people living with HIV accessing care in the era of antiretroviral therapy: Navigating the complexities of care","volume":"28","author":"Rajabiun","year":"2016","journal-title":"AIDS Care"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1007\/s11904-021-00559-w","article-title":"Interventions addressing depression and HIV-related outcomes in people with HIV","volume":"18","author":"Mendez","year":"2021","journal-title":"Curr. HIV\/AIDS Rep."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1097\/QAI.0000000000001102","article-title":"Critical review: When the party is over: A systematic review of behavioral interventions for substance-using men who have sex with men","volume":"73","author":"Carrico","year":"2016","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1080\/00224499.2020.1728514","article-title":"A systematic review and meta-analysis of combination behavioral interventions co-targeting psychosocial syndemics and HIV-related health behaviors for sexual minority men","volume":"57","author":"Pantalone","year":"2020","journal-title":"J. Sex Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1037\/amp0000319","article-title":"The science of team science: A review of the empirical evidence and research gaps on collaboration in science","volume":"73","author":"Hall","year":"2018","journal-title":"Am. Psychol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1097\/COH.0000000000000627","article-title":"Syndemics of HIV with mental illness and other noncommunicable diseases: A research agenda to address the gap between syndemic theory and current research practice","volume":"15","author":"Bhardwaj","year":"2020","journal-title":"Curr. Opin. HIV AIDS"},{"key":"ref_51","first-page":"1","article-title":"Syndemics theory and its applications to HIV\/AIDS public health interventions","volume":"6","year":"2016","journal-title":"Int. J. Med. Sociol. Anthropol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/8\/1231\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:25:17Z","timestamp":1760034317000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/8\/1231"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,7]]},"references-count":51,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["ijerph22081231"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22081231","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2025,8,7]]}}}