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Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
Published on: October 31, 2010
Co-occurring psychosocial problems predict HIV status and increased health care costs and utilization among sexual
Conall O'Cleirigh1,2, David W Pantalone3,4, Abigail W Batchelder5,3
1Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA. cocleirigh@mgh.harvard.edu.
Insights
Sexual minority men facing multiple syndemic indicators experience higher healthcare costs and utilization. These health disparities also significantly increase the risk of HIV infection.
Area of Science:
- Public Health
- Health Disparities
- Sexual Minority Health
Background:
- Sexual orientation disparities are documented, with sexual minority men facing mental health challenges due to minority stress.
- These mental health issues can synergistically increase societal medical costs.
Purpose of the Study:
- To investigate the association between sexual minority-specific syndemic indicators and healthcare costs, utilization, and HIV infection risk.
- To analyze the interrelation of syndemic indicators within this population.
Main Methods:
- A screening questionnaire was administered to 1211 healthcare consumers at a community health center over 12 months.
- Self-reported data were linked with clinical billing records.
- Adjusted logistic regression models were used to analyze the relationships between syndemic indicators, healthcare costs, utilization, and HIV status.
Main Results:
- Four syndemic indicators (suicidality, substance use, childhood sexual abuse, intimate partner violence) were significantly interrelated.
- Multiple syndemics significantly predicted higher medical care utilization and costs.
- Syndemic indicators were associated with a 2.5-fold increased risk of HIV infection (OR 2.49).
- No significant prediction was found for the number of mental health visits or costs per patient.
Conclusions:
- Syndemic indicators are significantly associated with increased healthcare utilization and costs among sexual minority men.
- These syndemic factors substantially elevate the risk of HIV infection in this population.
- Findings confirm and extend previous research by linking syndemics to tangible health service use and economic impacts for sexual minority men.
Abstract:
Sexual orientation related health disparities are well documented. Sexual minority men appear to be at risk for mental health problems due to the stress they experience in establishing and maintaining a minority sexual identity. These mental health issues may combine synergistically and lead to higher medical costs to society. We examine whether sexual minority specific syndemic indicators were associated with higher health care costs, health care utilization, or the risk of being HIV-infected. Health care consumers at a community health center (N = 1211) completed a brief screening questionnaire collected over 12 months. Self-reported data were linked with participants' clinical billing records. Adjusted logistic regression models identified that four syndemic indicators (suicidality, substance use, childhood sexual abuse, and intimate partner violence) were each significantly related to each other. Multiple syndemics significantly predicted higher medical care utilization and cost, and were associated with 2.5 times the risk of being HIV-infected (OR 2.49, 95% CI 1.45-4.25). Syndemic indicators did not significantly predict the number of mental health visits or costs per patient. These results confirm and extend earlier findings by relating syndemics to health services use and costs for sexual minority men.
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