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Syndemic Processes Among Young Men Who Have Sex With Men (MSM): Pathways Toward Risk and Resilience

Herrick, Amy (2011) Syndemic Processes Among Young Men Who Have Sex With Men (MSM): Pathways Toward Risk and Resilience. Doctoral Dissertation, University of Pittsburgh.

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    Abstract

    Men who have sex with men (MSM) in the US experience great disparities in health outcomes, most notably in HIV. This dissertation will take a look at these disparities and offer a framework for understanding their etiology and for understanding the processes by which these disparities are sustained, propagated and eventually broken down. First, we provide an overview of the literature regarding health disparities among MSM and the current theories that exist to understand where these disparities come from. Specifically, we focus on Syndemics Theory and the Theory of Syndemic Production as the best models for understanding health among MSM. Finally, we suggest a new theoretical model, Cultural Resilience Theory, which can be used to conceptualize health promotion within the syndemic framework. We also test components of Syndemics Theory - interaction and mediation - that until now have functioned as assumed premises with no empirical support for their assertion. Finally, we test Cultural Resilience Theory as a model that can be used in prevention programming to break down syndemic processes among MSM. In the final chapter we look into the practical implications of Cultural Resilience Theory as it applies to the prevention (or abatement) of health disparities among MSM.The findings of this study have great public health significance and important implications for HIV prevention among MSM. First, the synergism analysis is the first to test the assertion that co-occurring psychosocial health conditions interact to increase HIV risk among MSM. These results suggest that there is a synergistic effect present. Likewise, the mediation analysis is the first to test the theory of syndemic production that states that early life adversity impacts HIV outcomes through syndemic processes; an assertion that was supported by these analyses. These two studies further our understanding of how syndemics function within MSM to produce health disparities. Finally, we identify several variables that break down syndemic processes through either their negative association with poor health outcomes, or by buffering the pathways from adversity to HIV risk through syndemics. These results will provide the foundation upon which a culturally tailored Theory of Cultural Resilience among MSM can be developed.


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    Item Type: University of Pittsburgh ETD
    ETD Committee:
    ETD Committee TypeCommittee MemberEmail
    Committee ChairStall, Ronrstall@pitt.edu
    Committee MemberBurke, Jessicajgburke@pitt.edu
    Committee MemberFriedman, Markmsf11@pitt.edu
    Committee MemberMarshal, Mikemarsmp@upmc.edu
    Committee MemberMarkovic, Ninaninam@pitt.edu
    Title: Syndemic Processes Among Young Men Who Have Sex With Men (MSM): Pathways Toward Risk and Resilience
    Status: Unpublished
    Abstract: Men who have sex with men (MSM) in the US experience great disparities in health outcomes, most notably in HIV. This dissertation will take a look at these disparities and offer a framework for understanding their etiology and for understanding the processes by which these disparities are sustained, propagated and eventually broken down. First, we provide an overview of the literature regarding health disparities among MSM and the current theories that exist to understand where these disparities come from. Specifically, we focus on Syndemics Theory and the Theory of Syndemic Production as the best models for understanding health among MSM. Finally, we suggest a new theoretical model, Cultural Resilience Theory, which can be used to conceptualize health promotion within the syndemic framework. We also test components of Syndemics Theory - interaction and mediation - that until now have functioned as assumed premises with no empirical support for their assertion. Finally, we test Cultural Resilience Theory as a model that can be used in prevention programming to break down syndemic processes among MSM. In the final chapter we look into the practical implications of Cultural Resilience Theory as it applies to the prevention (or abatement) of health disparities among MSM.The findings of this study have great public health significance and important implications for HIV prevention among MSM. First, the synergism analysis is the first to test the assertion that co-occurring psychosocial health conditions interact to increase HIV risk among MSM. These results suggest that there is a synergistic effect present. Likewise, the mediation analysis is the first to test the theory of syndemic production that states that early life adversity impacts HIV outcomes through syndemic processes; an assertion that was supported by these analyses. These two studies further our understanding of how syndemics function within MSM to produce health disparities. Finally, we identify several variables that break down syndemic processes through either their negative association with poor health outcomes, or by buffering the pathways from adversity to HIV risk through syndemics. These results will provide the foundation upon which a culturally tailored Theory of Cultural Resilience among MSM can be developed.
    Date: 29 June 2011
    Date Type: Completion
    Defense Date: 08 April 2011
    Approval Date: 29 June 2011
    Submission Date: 07 April 2011
    Access Restriction: No restriction; The work is available for access worldwide immediately.
    Patent pending: No
    Institution: University of Pittsburgh
    Thesis Type: Doctoral Dissertation
    Refereed: Yes
    Degree: PhD - Doctor of Philosophy
    URN: etd-04072011-132447
    Uncontrolled Keywords: health disparities; HIV; MSM; syndemics
    Schools and Programs: Graduate School of Public Health > Behavioral and Community Health Sciences
    Date Deposited: 10 Nov 2011 14:35
    Last Modified: 25 Apr 2012 11:08
    Other ID: http://etd.library.pitt.edu/ETD/available/etd-04072011-132447/, etd-04072011-132447

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