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Structural Competency as a Global Framework for Syndemic HIV Care: A Critical Synthesis
Katerina Melino1,2, Adam Leonard1,2
1Katerina Melino, PhD, PMHNP-BC, is an Associate Clinical Professor, University of California San Francisco School of Nursing, San Francisco, California, USA.
The Journal of the Association of Nurses in AIDS Care : JANAC
|January 16, 2026
Summary
The co-occurrence of HIV with mental health disorders, substance use, and tuberculosis creates a syndemic that worsens health outcomes. Addressing the social and economic root causes through structural competency is crucial for improving care and treatment adherence.
Area of Science:
- Public Health
- Epidemiology
- Health Equity
Background:
- The co-occurrence of HIV with mental health disorders, substance use, and tuberculosis presents a significant global health challenge.
- Syndemic theory explains how these interconnected conditions interact to worsen health outcomes, reduce care engagement, and impede antiretroviral therapy adherence.
Purpose of the Study:
- To highlight the importance of structural competency in addressing the social, economic, and political determinants of health for individuals with HIV and co-occurring conditions.
- To advocate for a shift from individual-level interventions to holistic, multilevel approaches.
Main Methods:
- Conceptual analysis integrating syndemic theory and structural competency.
- Review of literature on the intersection of HIV, mental health, substance use, and tuberculosis.
Main Results:
- Synergistic interactions between HIV and other conditions exacerbate negative health impacts.
- Structural factors significantly influence health outcomes and treatment adherence.
- Individual-level interventions are insufficient to address the complex, intersecting nature of these health issues.
Conclusions:
- A structural competency framework is essential for understanding and addressing the root causes of health inequities.
- Healthcare providers should adopt multilevel approaches to improve outcomes for people affected by HIV and its syndemics.
- Addressing social, economic, and political determinants is key to improving care and adherence for this population.
Keywords:
HIVhealth inequitiesmental healthsocial determinants of healthsubstance usesyndemictuberculosisMore Related Videos
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