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Assessing a Syndemic of Discrimination, Material Insecurity, Depression, Substance Use, and Violence Among Sexual and
Rodman Turpin1, Megan E Mansfield2, Typhanye Dyer3
1Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, USA. rturpin@gmu.edu.
AIDS and Behavior
|August 23, 2025
Summary
Sexual and gender minority people in Nigeria face higher HIV rates due to a syndemic of discrimination, violence, and insecurity. Addressing these interconnected issues requires multilevel interventions for better health outcomes.
Area of Science:
- Public Health
- Social Epidemiology
- Health Disparities
Background:
- Sexual and gender minority (SGM) individuals in Nigeria experience a disproportionately high HIV burden, significantly exceeding the national average.
- Understanding the complex factors contributing to HIV vulnerability in this population is critical for developing effective interventions within a challenging socio-political environment.
Purpose of the Study:
- To assess a conceptual model of a syndemic encompassing discrimination, material insecurity, depression, substance use, intimate partner violence, and police violence among SGM in Abuja, Nigeria.
- To examine the intercorrelations among syndemic components and their association with HIV status.
- To qualitatively explore the syndemic's relevance and co-prevalence of its components within the SGM community.
Main Methods:
- Mixed-methods analysis combining quantitative intake data (n=515) and qualitative focus group data (n=36) from July 2023 to May 2024.
- Modified Poisson regression was used to test associations between a cumulative syndemic index and HIV status.
- Convergent qualitative assessment and co-prevalence analysis of syndemic components were conducted.
Main Results:
- Consistent intercorrelations among syndemic components provided evidence for a syndemic.
- Each quartile-unit increase in the syndemic index was associated with an 18% increase in HIV prevalence (aPR=1.18).
- Qualitative findings highlighted discrimination, material insecurity, and depression as particularly relevant, with strong co-prevalence observed between these and other syndemic factors.
Conclusions:
- A multilevel syndemic of discrimination, material insecurity, depression, substance use, intimate partner violence, and police violence significantly impacts the health of SGM in Abuja, Nigeria.
- Findings support the need for interventions addressing individual-level factors alongside broader social and structural changes.
- Multilevel intervention targets are essential to effectively mitigate HIV vulnerability and improve health outcomes for SGM in Nigeria.
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