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
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...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
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MDPI
2022
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| Subjects: | |
| Online Access: | http://hdl.handle.net/20.500.11937/88960 |
| _version_ | 1848765125127831552 |
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| author | Peprah, E. Myers-Franchi, Bronwyn Kengne, A.P. Peer, N. El-Shahawy, O. Ojo, T. Mukasa, B. Ezechi, O. Iwelunmor, J. Ryan, N. Sakho, F. Patena, J. Gyamfi, J. |
| author_facet | Peprah, E. Myers-Franchi, Bronwyn Kengne, A.P. Peer, N. El-Shahawy, O. Ojo, T. Mukasa, B. Ezechi, O. Iwelunmor, J. Ryan, N. Sakho, F. Patena, J. Gyamfi, J. |
| author_sort | Peprah, E. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | 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. |
| first_indexed | 2025-11-14T11:30:16Z |
| format | Journal Article |
| id | curtin-20.500.11937-88960 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T11:30:16Z |
| publishDate | 2022 |
| publisher | MDPI |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-889602022-08-29T07:12:15Z 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 Peprah, E. Myers-Franchi, Bronwyn Kengne, A.P. Peer, N. El-Shahawy, O. Ojo, T. Mukasa, B. Ezechi, O. Iwelunmor, J. Ryan, N. Sakho, F. Patena, J. Gyamfi, J. Science & Technology Life Sciences & Biomedicine Environmental Sciences Public, Environmental & Occupational Health Environmental Sciences & Ecology substance use people living with HIV (PWH) Africa syndemics SOUTH-AFRICA ABUSE TREATMENT USE DISORDERS ALCOHOL-USE CAPE-TOWN USE DRUGS HEALTH STRESS INFLAMMATION MECHANISMS 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. 2022 Journal Article http://hdl.handle.net/20.500.11937/88960 10.3390/ijerph19031097 English http://creativecommons.org/licenses/by/4.0/ MDPI fulltext |
| spellingShingle | Science & Technology Life Sciences & Biomedicine Environmental Sciences Public, Environmental & Occupational Health Environmental Sciences & Ecology substance use people living with HIV (PWH) Africa syndemics SOUTH-AFRICA ABUSE TREATMENT USE DISORDERS ALCOHOL-USE CAPE-TOWN USE DRUGS HEALTH STRESS INFLAMMATION MECHANISMS Peprah, E. Myers-Franchi, Bronwyn Kengne, A.P. Peer, N. El-Shahawy, O. Ojo, T. Mukasa, B. Ezechi, O. Iwelunmor, J. Ryan, N. Sakho, F. Patena, J. Gyamfi, J. 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 |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Science & Technology Life Sciences & Biomedicine Environmental Sciences Public, Environmental & Occupational Health Environmental Sciences & Ecology substance use people living with HIV (PWH) Africa syndemics SOUTH-AFRICA ABUSE TREATMENT USE DISORDERS ALCOHOL-USE CAPE-TOWN USE DRUGS HEALTH STRESS INFLAMMATION MECHANISMS |
| url | http://hdl.handle.net/20.500.11937/88960 |