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Using a Syndemics Framework to Understand How Substance Use Contributes to Morbidity and Mortality among People Living with HIV in Africa: A Call to Action

Author

Listed:
  • Emmanuel Peprah

    (Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA)

  • Bronwyn Myers

    (Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia
    Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
    Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7925, South Africa)

  • Andre-Pascal Kengne

    (Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
    Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa)

  • Nasheeta Peer

    (Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa)

  • Omar El-Shahawy

    (Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA
    Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
    Center for the Prevention of Heart Disease, John Hopkins Hospital, Baltimore, MD 21287, USA)

  • Temitope Ojo

    (Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA)

  • Barbara Mukasa

    (Mildmay Uganda, Kampala P.O. Box 24985, Uganda)

  • Oliver Ezechi

    (Nigerian Institute of Medical Research, Yaba, Lagos 101245, Nigeria)

  • Juliet Iwelunmor

    (College for Public Health and Social Justice, Department of Behavioral Science and Health Education, Saint Louis University, St. Louis, MO 63104, USA)

  • Nessa Ryan

    (Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA)

  • Fatoumata Sakho

    (Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA)

  • John Patena

    (Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA)

  • Joyce Gyamfi

    (Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA)

Abstract

Substance use is increasing throughout Africa, with the prevalence of alcohol, tobacco, cannabis, and other substance use varying regionally. Concurrently, sub-Saharan Africa bears the world’s largest HIV burden, with 71% of people living with HIV (PWH) living in Africa. Problematic alcohol, tobacco, and other substance use among PWH is associated with multiple vulnerabilities comprising complex behavioral, physiological, and psychological pathways that include high-risk behaviors (e.g., sexual risk-taking), HIV disease progression, and mental health problems, all of which contribute to nonadherence to antiretroviral therapy. Physiologically, severe substance use disorders are associated with increased levels of biological markers of inflammation; these, in turn, are linked to increased mortality among PWH. The biological mechanisms that underlie the increased risk of substance use among PWH remain unclear. Moreover, the biobehavioral mechanisms by which substance use contributes to adverse health outcomes are understudied in low- and middle-income countries (LMIC). Syndemic approaches to understanding the co-occurrence of substance use and HIV have largely been limited to high-income countries. We propose a syndemic coupling conceptual model to disentangle substance use from vulnerabilities to elucidate underlying disease risk for PWH. This interventionist perspective enables assessment of biobehavioral mechanisms and identifies malleable targets of intervention.

Suggested Citation

  • Emmanuel Peprah & Bronwyn Myers & Andre-Pascal Kengne & Nasheeta Peer & Omar El-Shahawy & Temitope Ojo & Barbara Mukasa & Oliver Ezechi & Juliet Iwelunmor & Nessa Ryan & Fatoumata Sakho & John Patena , 2022. "Using a Syndemics Framework to Understand How Substance Use Contributes to Morbidity and Mortality among People Living with HIV in Africa: A Call to Action," IJERPH, MDPI, vol. 19(3), pages 1-12, January.
  • Handle: RePEc:gam:jijerp:v:19:y:2022:i:3:p:1097-:d:728398
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    References listed on IDEAS

    as
    1. Turan, B. & Hatcher, A.M. & Weiser, S.D. & Johnson, M.O. & Rice, W.S. & Turan, J.M., 2017. "Framing mechanisms linking HIV-related stigma, adherence to treatment, and health outcomes," American Journal of Public Health, American Public Health Association, vol. 107(6), pages 863-869.
    2. repec:aph:ajpbhl:10.2105/ajph.2017.303744_4 is not listed on IDEAS
    3. Emmanuel Peprah & Mari Armstrong-Hough & Stephanie H. Cook & Barbara Mukasa & Jacquelyn Y. Taylor & Huichun Xu & Linda Chang & Joyce Gyamfi & Nessa Ryan & Temitope Ojo & Anya Snyder & Juliet Iwelunmor, 2021. "An Emerging Syndemic of Smoking and Cardiopulmonary Diseases in People Living with HIV in Africa," IJERPH, MDPI, vol. 18(6), pages 1-12, March.
    4. Helen A. Weiss & Judith Vandepitte & Justine N. Bukenya & Yunia Mayanja & Susan Nakubulwa & Anatoli Kamali & Janet Seeley & Heiner Grosskurth, 2016. "High Levels of Persistent Problem Drinking in Women at High Risk for HIV in Kampala, Uganda: A Prospective Cohort Study," IJERPH, MDPI, vol. 13(2), pages 1-15, January.
    5. Rehana Kader & Rajen Govender & Soraya Seedat & John Randy Koch & Charles Parry, 2015. "Understanding the Impact of Hazardous and Harmful Use of Alcohol and/or Other Drugs on ARV Adherence and Disease Progression," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-12, May.
    Full references (including those not matched with items on IDEAS)

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