Using Syndemics Theory to Investigate Risk and Protective Factors Associated with Condomless Sex Among Youth Living with HIV in 17 U.S. Cities

AIDS Behav. 2017 Mar;21(3):833-844. doi: 10.1007/s10461-016-1550-3.


Identifying risk and protective factors associated with condomless sex among youth living with HIV is imperative for developing effective HIV prevention strategies. A cross-sectional sample of 1728 participants, 12-26 years of age, recruited from adolescent medicine clinics in 17 U.S. cities completed an audio-computer assisted self-interview with questions about their substance use, psychosocial factors, and attitudinal and behavioral factors. Guided by syndemics theory, a path analysis was used to assess the interrelations of these factors. Analyses of model fit statistics indicated statistically significant direct pathways between substance use, psychosocial factors, self-efficacy for risk-reduction, alternative risk-reduction attitudes and behaviors and condomless sex. The total indirect effect of self-efficacy for risk-reduction on condomless sex through alternative risk-reduction attitudes and behaviors was also significant. Multi-faceted, tailored interventions that address individual risk and protective factors and their combined synergistic effects are urgently needed to prevent condomless sex among this population.

Keywords: Condomless sex; HIV prevention; Structural equation modeling; Syndemics theory; Youth living with HIV.

MeSH terms

  • Adolescent
  • Attitude to Health
  • Cities
  • Condoms / statistics & numerical data*
  • Cross-Sectional Studies
  • Female
  • HIV Infections / epidemiology*
  • HIV Infections / prevention & control
  • Homosexuality, Male / psychology
  • Homosexuality, Male / statistics & numerical data*
  • Humans
  • Male
  • Protective Factors*
  • Risk-Taking*
  • Self Efficacy
  • Substance-Related Disorders / epidemiology
  • Unsafe Sex / statistics & numerical data*