Syndemic

Syndemics combine the synergies of epidemics to evaluate how social and health conditions travel together, in what ways they interact, and what upstream drivers may produce their interactions. ^[1] The idea of syndemics is that no disease exists in isolation and that often population health can be understood through a confluence of factors (such as climate change or social inequality) that produces multiple health conditions that afflict some populations and not others. ^[2] Syndemics are not like pandemics (where the same social forces produce clustered conditions equally around the world); instead, syndemics reflect population-level trends within certain states, regions, cities, or towns. ^{[3] [4]}

A syndemic or synergistic epidemic is generally understood to be the aggregation of two or more concurrent or sequential epidemics or disease clusters in a population with biological interactions, which exacerbate the prognosis and burden of disease. The term was developed by Merrill Singer in the early 1990s to call attention to the synergistic nature of the health and social problems facing the poor and underserved. ^[5] Syndemics develop under health disparity, caused by poverty, stress, climate, or structural violence and are studied by epidemiologists and medical anthropologists concerned with public health, community health and the effects of social conditions on health. The concept was translated from anthropology to a larger audience in 2017, with the publication of a Series on Syndemics in The Lancet , led by Emily Mendenhall. ^[6]

The syndemic approach departs from the biomedical approach to diseases to diagnostically isolate, study, and treat diseases as distinct entities separate from other diseases and independent of social contexts.

Definition

A syndemic is a synergistic epidemic. The term was developed by Merrill Singer in the mid-1990s, culminating in a 2009 textbook. ^[7] Disease concentration, disease interaction, and their underlying social forces are the core concepts. ^[8] Disease co-occurrence, with or without interactions, is known as comorbidity and coinfection. The difference between "comorbid" and "syndemic" is per Mustanski et al. ^{[9] [10]} "comorbidity research tends to focus on the nosological issues of boundaries and overlap of diagnoses, while syndemic research focuses on communities experiencing co-occurring epidemics that additively increase negative health consequences." It is possible for two afflictions to be comorbid, but not syndemic i.e., the disorders are not epidemic in the studied population, or their co-occurrence does not cause an interaction that then contributes to worsened health. Two or more diseases can be comorbid without interactions, or interaction occurs but it is beneficial, not deleterious. Syndemic theory seeks to draw attention to and provide a framework for the analysis of adverse disease interactions, including their causes and consequences for human life and well-being. ^[11] Although the majority of this research has focused on HIV, ^[12] an emerging body of work on syndemics has expanded to other co-occurring conditions. ^{[13] [14]}

Syndemic Methods: from historical archives to mathematical models

Methods for evaluating syndemics have been a focus on scholarship for deepening the application of what has largely served as theory to understand why and how social and health conditions cluster together, interact, and are driven by shared forces, from climate (such as escalation of heat, rain, drought, and events) to poverty (such as food insecurity, poor housing, lack of safety, and limited work opportunities). ^[15] In 2022, Alexander Tsai (an epidemiologist), Emily Mendenhall (a medical anthropologist), and Timothy Newfield (a historian) teamed up on a Special Issue in Social Science and Medicine to explore the various methodological ways in which syndemics can be understood, interpreted, and evaluated through history. ^[16] For instance, historical syndemics may be evaluated using archival data that is incomplete but provides a novel way of thinking about disease biography. ^[17] This is exemplified by Dylann Atcher Proctor's historical work on gastrointestinal distress in Gabon using historical archives that had never yet been evaluated on their own or synergistically. ^[18]

Ethnographic data provides a deeper understanding of how and why larger social forces produce disease clusters and interactions and are crucial for understanding "why" syndemics occurr. Ethnographic insights have served as the bedrock of syndemic thinking since Merrill Singer's pioneering intellectual and practical work with the concept beginning in the 1990s. His first article based on ethnographic thinking about the SAVA Syndemic came from real time observations as the AIDS epidemic that unfolded in tandem with substance use amidst structural violence in urban America throughout the 1990s and early 2000s. ^[19] Singer demonstrated how it was impossible to think about one condition without contextualizing the broader social, structural, and health contexts in which people lived. Discussion of ethnographic methods were detailed in Emily Mendenhall's books Syndemic Suffering ^[20] and Rethinking Diabetes ^[21] and is also exemplified in Mac Marshall's book Drinking Smoke. ^[22]

The largest body of methodological scholarship has emerged around the utility of epidemiological data. ^[23] Epidemiological data provides opportunities to investigate the synergistic ways in which diseases emerge and interact with social and health conditions. ^[24] This latter method has been the focus of contention, particularly in dialogue between Alexander Tsai and Ronald Stall. ^{[25] [26]} Early epidemiological studies, for example, evaluated the ways in which social and health conditions co-occurred. Tsai argued that instead, there is a deeper need to interrogate how conditions syngistically interact to cause more adverse health conditions that the conditions would produce on their own. This has led to a slough of emergent research interrogating mathematical models that can take seriously how health conditions may cluster together and interact to affect the health and well being of populations residing in a specific nation, region, city, or town. A particularly useful model based on the Soweto Syndemics study was published in Nature Human Behavior. ^[27] In particular, spatial models for thinking through syndemic clusters, such as using GIS, are an emerging area of interest in syndemics research. ^{[28] [29]}

Types of disease interaction

Diseases regularly interact and this interaction influences disease course, expression, severity, transmission, and diffusion. Interaction among diseases may be both indirect (changes caused by one disease that facilitate another through an intermediary) and direct (diseases act in direct tandem).^{[ citation needed ]}

• One disease can assist the physical transmission of the microbe causing another disease, for example, genital-tract ulceration caused by syphilis allowing sexual transmission of HIV.^{[ citation needed ]}
• One disease may enhance the virulence of another, as for example, herpes simplex virus co-infection exacerbates HIV infection with progression to AIDS,^{[ citation needed ]} periodontal bacteria may enhance the virulence of herpesvirus,^{[ citation needed ]} HIV-infected individuals are more susceptible to tuberculosis; As of 2011, the cause was not fully understood. ^{[30] [31] [32]}
• Changes in biochemistry or damage to organ systems, as for example diabetes weakening the immune system, promotes the progression of another disease, SARS.^{[ citation needed ]}
• A coinfection may open up multiple syndemic pathways. Lethal synergism between influenza virus and pneumococcus, causes excess mortality from secondary bacterial pneumonia during influenza epidemics. Influenza virus alters the lungs in ways that increase the adherence, invasion and induction of disease by pneumococcus, alters the immune response with weakened ability to clear pneumococcus or, alternately amplifying the inflammatory cascade. ^[33]
• Direct interaction of diseases occurs in the case of genetic recombination among different pathogens, for instance between Avian sarcoma leukosis virus and Marek's disease virus (MDV) in domestic fowl.^{[ citation needed ]} Both cancer-causing viruses are known to infect the same poultry flock, the same chicken, and, even the same anatomic cell. In coinfected cells, the retroviral DNA of the avian leukosis virus can integrate into the MDV genome, producing altered biological properties compared to those of the parental MDV. The frequency of gene reassortment among human pathogens is less clear than it is the among plant or animal species but of concern as animal diseases adapt to human hosts and as man new diseases comes into contact.^{[ citation needed ]}
• When one disease diminishes or eradicates another it is a counter-syndemic disease interaction.^{[ citation needed ]}
• The linkage also may not be clear, despite apparent syndemic interactions among diseases, as for example in type 2 diabetes mellitus and hepatitis C virus infection.^{[ citation needed ]}

Iatrogenic

The term iatrogenesis refers to adverse effects on health caused by medical treatment. This is possible if medical treatment or medical research creates conditions that increase the likelihood that two or more diseases come together in a population. For example, if gene splicing unites two pathogenic agents and the resulting novel organism infects a population. One study suggests the possibility of iatriogenic syndemics. During a randomized, double-blind clinical trial testing the efficacy of the prototype HIV vaccine called V520 there appeared to be an increased risk for HIV infection among the vaccinated participants. Notably, participants immune to the common cold virus adenovirus type 5 had a higher risk of HIV infection. The vaccine was created using a replication-defective version of Ad5 as a carrier, or delivery vector, for three synthetically produced HIV genes. On November 6, 2007, Merck & Co. announced that research had been stopped suspecting the higher rate of HIV infection among individuals in the vaccinated was because the vaccine lowered defenses against HIV.^{[ citation needed ]}

Examples

Various syndemics though not always labeled as such have been described in the literature, including:

• SAVA syndemic (substance abuse, violence and AIDS, ^{[34] [35] [36] [37] [38]}
• the VIDDA syndemic (violence, immigration/isolation, depression, diabetes, abuse) ^[39]
• the hookworm, malaria and HIV/AIDS syndemic, ^[40]
• the Chagas disease, rheumatic heart disease and congestive heart failure syndemic, ^[41]
• the possible asthma and infectious disease syndemic, ^[42]
• the malnutrition and depression syndemic,^{[ citation needed ]}
• the TB, HIV and violence syndemic, ^[43]
• the whooping cough, influenza, tuberculosis syndemic, ^{[ citation needed ]}
• the HIV incidence, substance use, mental health, childhood sexual abuse, and intimate partner violence syndemics ^[44]
• the HIV and STD syndemic,^{[ citation needed ]}
• the stress and obesity syndemic, ^{[45] [46] [47]}
• the HIV infection, mental health and substance abuse syndemic. ^[48]
• the built environment, physical inactivity and obesity/diabetes syndemic, which Prince Charles pointed out in January 2006, in a speech at the Enhancing the Healing Environment conference hosted by The Prince's Foundation for the Built Environment and The King's Fund, St James's Palace, London.^{[ citation needed ]}
• HIV infection and opportunistic microbial infections and viral-caused malignancies like Kaposi's sarcoma ^{[ citation needed ]}
• periodontitis and herpes virus: bacteria of several different species (e.g., Porphyromonas gingivalis , Dialister pneumosintes, Prevotella intermedia ) that adhere to and reproduce on tooth surfaces under the gum line multiply when bodily defenses are weakened by an HSV infection of the periodontium.^{[ citation needed ]}
• HIV being transiently suppressed during an acute measles infection. Several potential mechanisms could be responsible. Measles virus infection causes lymphopenia, a reduction in the number of CD4+ T lymphocytes circulating in the blood. The low point occurs just prior to the onset of the characteristic skin rash. Within a month of this nadir, the number of lymphocytes returns to normal levels. The drop in HIV virus levels may be due to a lack of target CD4+ T cells in which they replicate, or measles virus may stimulate the production of proteins suppressing HIV replication, including the β-chemokines, CD8+ cell noncytotoxic anti-HIV response, and the cytokines IL-10 and IL-16. median plasma levels of RANTES, a chemokine that attracts immune system components like eosinophils, monocytes, and lymphocytes were higher in HIV-infected children with measles than in those without measles (Moss and co-workers).^{[ citation needed ]}
• HIV suppression in tsutsugamuchi disease or scrub typhus, a mite-borne infection in Asia and Australia, but how this occurs is unclear.^{[ citation needed ]}
• COVID-19 is a syndemic of SARS‑CoV‑2 coronavirus infection combined with an epidemic of non-communicable diseases, both inter-acting on a social substrate of poverty and inequality, according to Richard Horton in the Lancet Global Burden of Disease study 2020 (GBD 2020).

19th century Native American

Contact between Native Americans and Europeans during the Columbian Exchange led to lethal syndemics within the Native American population due to diseases introduced which the Native Americans had not encountered before and had not built-up immunity to.^{[ citation needed ]}

An example of a syndemic from the 19th century can be found on the reservations on which Native Americans were confined with the closing of the U.S. frontier. It is estimated that in 1860 there were well over 10 million bison living on the American Plains. By the early 1880s, the last of the great herds of bison upon which Plains Indian peoples like the Sioux were dependent as a food source were gone. At the same time, after the U.S. military's defeat at the Battle of the Little Bighorn in 1876, there was a concerted effort to beat the Sioux into total submission. Thus, in 1872, Secretary of the Interior Columbus Delano stated: "as they become convinced that they can no longer rely upon the supply of game for their support, they will return to the more reliable source of subsistence [i.e., farming]." As a result, they were forced to give up their struggle for an independent existence on their own lands and take up reservation life at the mercy of government authority. Treaties that were signed with the Sioux in 1868 and 1876 stipulated that they would be provided with government annuities and provisions in payment for sections of their land and with the expectation among federal representatives that the Sioux would become farmers on individually held plots of land. The Sioux found themselves confined on a series of small reservations where they were treated as a conquered people. Moreover, the government reneged on its promises, food was insufficient and of low quality. Black Elk, a noted Sioux folk healer, told his biographer: "There was hunger among my people before I went across the big water [to Europe in 1886], because the Wasichus [whites] did not give us all the food they promised in the Black Hills treaty... But it was worse when I came back [1889]. My people looked pitiful... We could not eat lies and there was nothing we could do." Under extremely stressful conditions, with inadequate diets, and as victims of overt racism on the part of the registration agents appointed to oversee Indian reserves, the Sioux confronted infectious disease from contact with whites. knowledge about the epidemiology of the Sioux from this period is limited, James Mooney, an anthropologist and representative of the Bureau of Indian Affairs sent to investigate a possible Sioux rebellion, described the health situation on the reservation in 1896: "In 1888 their cattle had been diminished by disease. In 1889, their crops were a failure ... Thus followed epidemics of measles, grippe [influenza], and whooping cough Pertussis, in rapid succession and with terrible fatal results..." Similarly, the Handbook of American Indians notes, "The least hopeful conditions in this respect prevail among the Dakota [Sioux] and other tribes of the colder northern regions, where pulmonary tuberculosis and scrofula are very common... Other more common diseases, are various forms of, bronchitis ...pneumonia, pleurisy, and measles in the young. Whooping cough is also met with." Indian children were removed to white boarding schools and diagnosed with a wide range of diseases, including tuberculosis, trachoma, measles, smallpox, whooping cough, influenza, and pneumonia.^{[ citation needed ]}

The Sioux were victims of a syndemic of interacting infectious diseases including the 1889–1890 flu pandemic, inadequate diet, and stressful and extremely disheartening life conditions, including outright brutalization with events like the massacre at Wounded Knee in 1890 and the murder of their leader Sitting Bull. While the official mortality rate on the reservation was between one and two percent, the death rate was probably closer to 10 percent.^{[ citation needed ]}

Influenza

There were three influenza pandemics during the 20th century that caused widespread illness, mortality, social disruption, and significant economic losses. These occurred in 1918, 1957, and 1968. In each case, mortality rates were determined primarily by five factors: the number of people who became infected, the virulence of the virus causing the pandemic, the speed of global spread, the underlying features and vulnerabilities of the most affected populations, and the effectiveness and timeliness of the prevention and treatment measures that were implemented.^{[ citation needed ]}

The 1957 pandemic was caused by the Asian influenza virus (known as the H2N2 strain), a novel influenza variety to which humans had not yet developed immunities. The death toll of the 1957 pandemic is estimated to have been around two million globally, with approximately 70,000 deaths in the United States. A little over a decade later, the comparatively mild Hong Kong influenza pandemic erupted due to the spread of a virus strain (H3N2) that genetically was related to the more deadly form seen in 1957. The pandemic was responsible for about one million deaths around the world, almost 34,000 of which were in the United States. In both of these pandemics, death may not have been due only to the primary viral infection, but also to secondary bacterial infections among influenza patients; in short, they were caused by a viral/bacterial syndemic (but see Chatterjee 2007).

The worst of the 20th-century influenza pandemics was the 1918 pandemic, where between 20 and 40 percent of the world's population became ill and between 40 and 100 million people died. More people died of the so-called Spanish flu (caused by the H1N1 viral strain) pandemic in the single year of 1918 than during all four-years of the Black Death. The pandemic had devastating effects as disease spread along trade and shipping routes and other corridors of human movement until it had circled the globe. In India, the mortality rate reached 50 per 1,000 population. Arriving during the closing phase of World War I, the pandemic impacted mobilized national armies. Half of U.S. soldiers who died in the "Great War," for example, were victims of influenza. It is estimated that almost 3⁄4 of a million Americans died during the pandemic. In part, the death toll during the pandemic was caused by viral pneumonia characterized by extensive bleeding in the lungs resulting in suffocation. Many victims died within 48 hours of the appearance of the first symptom. It was not uncommon for people who appeared to be quite healthy in the morning to have died by sunset. Among those who survived the first several days, however, many died of secondary bacterial pneumonia. It has been argued that countless numbers of those who expired quickly from the disease were co-infected with tuberculosis, which would explain the notable plummet in TB cases after 1918.^{[ citation needed ]}

Climate change

As a result of the floral changes produced by global warming, an escalation is occurring in global rates of allergies and asthma. Allergic diseases constitute the sixth leading cause of chronic illness in the United States, impacting 17 percent of the population. Asthma affects about 8 percent of the U.S. population, with rising tendency, especially in low income, ethnic minority neighborhoods in cities. In 1980 asthma affected only about three percent of the U.S. population according to the U.S. CDC. Asthma among children has been increasing at an even faster pace than among adults, with the percentage of children with asthma going up from 3.6 percent in 1980 to 9 percent in 2005. Among ethnic minority populations, like Puerto Ricans the rate of asthma is 125 percent higher than non-Hispanic white people and 80 percent higher than non-Hispanic black people. The asthma prevalence among American Indians, Alaska Natives and black people is 25 percent higher than in white people.^{[ citation needed ]}

Air pollution

Increases in asthma rates have occurred despite improvements in air quality produced by the passage and enforcement of clean air legislation, such as the U.S. Clean Air Act of 1963 and the Clean Air Act of 1990. Existing legislation and regulation have not kept pace with changing climatic conditions and their health consequences. Compounding the problem of air quality is the fact that air-borne pollens have been found to attach themselves to diesel particles from truck or other vehicular exhaust floating in the air, resulting in heightened rates of asthma in areas where busy roads bisect densely populated areas, most notably in poorer inner-city areas.

For every elevation of 10 μg/m3 in particulate matter concentration in the air a six percent increase in cardiopulmonary deaths occurs according to research by the American Cancer Society. Exhaust from the burning of diesel fuel is a complex mixture of vapors, gases, and fine particles, including over 40 known pollutants like nitrogen oxide and known or suspected carcinogenic substances such as benzene, arsenic, and formaldehyde. Exposure to diesel exhaust irritates the eyes, nose, throat and lungs, causing coughs, headaches, light-headedness and nausea, while causing people with allergies to be more susceptible allergy triggers like dust or pollen. Many particles in disease fuel are so tiny they are able to penetrate deep into the lungs when inhaled. Importantly, diesel fuel particles appear to have even greater immunologic effects in the presence of environmental allergens than they do alone. "This immunologic evidence may help explain the epidemiologic studies indicating that children living along major trucking thoroughfares are at increased risk for asthmatic and allergic symptoms and are more likely to have respiratory dysfunction." according to Robert Pandya and co-workers.^{[ citation needed ]}

The damaging effects of diesel fuel pollution go beyond a synergistic role in asthma development. Exposure to a combination of microscopic diesel fuel particles among people with high blood cholesterol (i.e., low-density lipoprotein, LDL or "bad cholesterol") increases the risk for both heart attack and stroke above levels found among those exposed to only one of these health risks. According to André Nel, Chief of Nanomedicine at the David Geffen School of Medicine at UCLA, "When you add one plus one, it normally totals two... But we found that adding diesel particles to cholesterol fats equals three. Their combination creates a dangerous synergy that wreaks cardiovascular havoc far beyond what's caused by the diesel or cholesterol alone." Experimentation revealed that the two mechanisms worked in tandem to stimulate genes that promote cell inflammation, a primary risk for hardening and blockage of blood vessels (atherosclerosis ) and, as narrowed arteries collect cholesterol deposits and trigger blood clots, for heart attacks and strokes as well.^{[ citation needed ]}

A Note on Mathematical Models

A mathematical model is a simplified representation using mathematical language to describe natural, mechanical or social system dynamics. Epidemiological modelers unite several types of information and analytic capacity, including: 1) mathematical equations and computational algorithms; 2) computer technology; 3) epidemiological knowledge about infectious disease dynamics, including information about specific pathogens and disease vectors; and 4) research data on social conditions and human behavior. Mathematical modelling in epidemiology is now being applied to syndemics.^{[ citation needed ]}

For example, modelling to quantify the syndemic effects of malaria and HIV in sub-Saharan Africa based on research in Kisumu, Kenya researchers found that 5% of HIV infections (or 8,500 cases of HIV since 1980) in Kisumu are the result of the higher HIV infectiousness of malaria-infected HIV patients. Additionally, their model attributed 10% of adult malaria episodes (or almost one million excess malaria infections since 1980) to the greater susceptibility of HIV infected individuals to malaria. Their model also suggests that HIV has contributed to the wider geographic spread of malaria in Africa, a process previously thought to be the consequence primarily of global warming. ^[49] Modelling offers an enormously useful tool for anticipating future syndemics, including eco-syndemic, based on information about the spread of various diseases across the planet and the consequent co-infections and disease interactions that will result. ^[50]

PopMod is a longitudinal population tool developed in 2003 that models distinct and possibly interacting diseases. Unlike other life-table population models, PopMod is designed to not assume the statistical independence of the diseases of interest. The PopMod has several intended purposes, including describing the time evolution of population health for standard demographic purposes (such as estimating healthy life expectancy in a population), and providing a standard measure of effectiveness for health interventions and cost-effectiveness analysis. PopMod is used as one of the standard tools of the World Health Organization's (WHO) CHOICE (Choosing Interventions that are Cost-Effective) program, an initiative designed to provide national health policymakers in the WHO's 14 epidemiological sub-regions around the world with findings on a range of health intervention costs and effects. ^[51]

Future research

First, there is a need for studies that examine the processes by which syndemics emerge, the specific sets of health and social conditions that foster multiple epidemics in a population and how syndemics function to produce specific kinds of health outcomes in populations.^{[ citation needed ]} Second, there is a need to better understand processes of interaction between specific diseases with each other and with health-related factors like malnutrition, structural violence, discrimination, stigmatization, and toxic environmental exposure that reflect oppressive social relationships. There is a need to identify all of the ways, directly and indirectly, that diseases can interact and have, as a result, enhanced impact on human health. Third there is a need for the development of an eco-syndemic understanding of the ways in which global warming contributes to the spread of diseases and new disease interactions. There is a need for a better understanding of how public health systems and communities can best respond to and limit the health consequences of syndemics. Systems are needed to monitor the emergence of syndemics and to allow early medical and public health responses to lessen their impact. Systematic ethno-epidemiological surveillance with populations subject to multiple social stressors must be one component of such a monitoring system.

See also

• Endemic
• List of epidemics
• List of human diseases associated with infectious pathogens

References

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30. Diedrich CR.; Flynn J. (2011). "HIV-1/Mycobacterium tuberculosis Coinfection Immunology: How Does HIV-1 Exacerbate Tuberculosis?". Infection and Immunity. 79 (4): 1407–17. doi:10.1128/iai.01126-10. PMC   3067569 . PMID   21245275.
31. Cain K.; Kanara N.; Laserson K.; Vannarith C.; Sameourn K.; Samnang K.; Qualls M.; Varma J. (2007). "The Epidemiology of HIV-associated Tuberculosis in Rural Cambodia". International Journal of Tuberculosis and Lung Disease. 11 (9): 1008–13. PMID   17705980.
32. Cain, Kevin, Anekthananon, Thanomsak, Burapat, Channawong, Akksilp, Somsak, Mankhatitham, Wiroj, Srinak, Chawin, Nateniyom, Sriprapa, Sattayawuthipong, Wanchai, Tasaneeyapan, Theerawit, and Varma, Jay 2009 "Causes of Death in HIV-infected Persons Who Have Tuberculosis, Thailand". Emerging Infectious Diseases 15(2). Available from https://www.cdc.gov/EID/content/15/2/258.htm
33. McCullers Jonathon (2006). "Insights into the Interaction between Influenza Virus and Pneumococcus". Clinical Microbiology Reviews. 19 (3): 571–82. doi:10.1128/cmr.00058-05. PMC   1539103 . PMID   16847087.
34. Meyer, Jaimie P.; Springer, Sandra A.; Altice, Frederick L. (July 2011). "Substance Abuse, Violence, and HIV in Women: A Literature Review of the Syndemic". Journal of Women's Health . 20 (7): 991–1006. doi:10.1089/jwh.2010.2328. PMC   3130513 . PMID   21668380.
35. Feingold Abraham (2009). "SAVA Latina: Addressing the Interplay of Substance Abuse, Violence, & AIDS Affecting Hispanic Women (Part 1)". Mental Health AIDS. 10 (3): 4–8.
36. Illangasekare S.; Burke J.; Chander G.; Gielen A. (2013). "The Syndemic Effects of Intimate Partner Violence, HIV/AIDS, and Substance Abuse on Depression among Low-Income Urban Women". Journal of Urban Health. 90 (5): 934–47. doi:10.1007/s11524-013-9797-8. PMC   3795184 . PMID   23529665.
37. Yuwen Weicho (2012). "In Response to the Published Article "A Syndemic Model of Substance Abuse, Intimate Partner Violence, HIV Infection, and Mental Health among Hispanics"". Public Health Nursing. 29 (5): 388–89. doi:10.1111/j.1525-1446.2012.01028.x. PMID   22924561.
38. Senn Theresa; Carey Michael; Vanable Peter (2010). "The Intersection of Violence, Substance Use, Depression, and STDs: Testing of a Syndemic Pattern Among Patients Attending an Urban STD Clinic". Journal of the National Medical Association. 102 (7): 614–20. doi:10.1016/S0027-9684(15)30639-8. PMC   2935202 . PMID   20690325.
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40. Singer, Merrill (2013). "Development, coinfection, and the syndemics of pregnancy in Sub-Saharan Africa". Infectious Diseases of Poverty. 2 (1): 26. doi: 10.1186/2049-9957-2-26 . PMC   4177213 . PMID   24237997.
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Further reading

Books

• Marshall, Mac 2013 Drinking Smoke: The Tobacco Syndemic in Oceania. Honolulu, HI: University of Hawaiʻi Press.
• Mendenhall, Emily 2012 Syndemic Suffering: Social Distress, Depression, and Diabetes among Mexican Immigrant Women. Left Coast Press, Inc.
• Singer, Merrill 2009 Introduction to Syndemics: A Critical Systems Approach to Public and Community Health. San Francisco, CA: Jossey-Bass.

Articles, chapters

• Alisjahbana, B.; van Crevel, R.; Sahiratmadja, E.; den Heijer, M.; Maya, A.; Istriana, E.; Danusantoso, H.; Ottenhoff, T. H. M.; Nelwan, R. H. H.; van der Meer, J. W. M. (June 1, 2006). "Diabetes mellitus is strongly associated with tuberculosis in Indonesia". The International Journal of Tuberculosis and Lung Disease. 10 (6): 696–700. PMID   16776459.
• Andreani, Guadalupe; Lodge, Robert; Richard, Dave; Tremblay, Michel J. (May 2012). "Mechanisms of interaction between protozoan parasites and HIV". Current Opinion in HIV and AIDS. 7 (3): 275–281. doi:10.1097/COH.0b013e32835211e9. PMID   22418447. S2CID   20452015.
• Biello, K.B., Colby, D., Closson, E., Mimiaga, M.J., 2014. "The syndemic condition of psychosocial problems and HIV risk among male sex workers in Ho Chi Minh City, Vietnam". AIDS Behav 18, 1264–1271. doi:10.1007/s10461-013-0632-8.
• Biello, K.B., Oldenburg, C.E., Safren, S.A., Rosenberger, J.G., Novak, D.S., Mayer, K.H., Mimiaga, M.J., 2016. Multiple syndemic psychosocial factors are associated with reduced engagement in HIV care among a multinational, online sample of HIV-infected MSM in Latin America. AIDS Care 28 Suppl 1, 84–91. https://doi.org/10.1080/09540121.2016.1146205
• Blashill AJ, Bedoya CA, Mayer KH, O'Cleirigh C, Pinkston MM, Remmert JE, Mimiaga MJ, Safren SA. Psychosocial Syndemics are Additively Associated with Worse ART Adherence in HIV-Infected Individuals. AIDS Behav. 2015 Jun;19(6):981-6. doi: 10.1007/s10461-014-0925-6. PMID 25331267; PMCID: PMC4405426.
• Bini, Edmund J.; Perumalswami, Ponni V. (2010). "Hepatitis B virus infection among American patients with chronic hepatitis C virus infection: Prevalence, racial/ethnic differences, and viral interactions". Hepatology. 51 (3): 759–66. doi: 10.1002/hep.23461 . PMID   20140950.
• Brennan, Julia; Kuhns, Lisa M.; Johnson, Amy K.; Belzer, Marvin; Wilson, Erin C.; Garofalo, Robert; Adolescent Medicine Trials Network for HIV/AIDS Interventions (September 2012). "Syndemic Theory and HIV-Related Risk Among Young Transgender Women: The Role of Multiple, Co-Occurring Health Problems and Social Marginalization". American Journal of Public Health. 102 (9): 1751–1757. doi:10.2105/AJPH.2011.300433. PMC   3416048 . PMID   22873480.
• Bruce, Douglas; Harper, Gary W.; Adolescent Medicine Trials Network for HIV/AIDS, Interventions. (August 2011). "Operating Without a Safety Net: Gay Male Adolescents and Emerging Adults' Experiences of Marginalization and Migration, and Implications for Theory of Syndemic Production of Health Disparities". Health Education & Behavior. 38 (4): 367–378. doi:10.1177/1090198110375911. PMC   3149744 . PMID   21398621.
• David, Brunarski (2011). "The Increasing Threat of Syndemics and the Role of Chiropractic Care". Dynamic Chiropractic. 4 (2): 1.^{[ permanent dead link ]} http://www.dynamicchiropractic.ca/mpacms/dc_ca/article.php?id=55088&no_paginate=true&p_friendly=true&no_b=true%5B%5D
• Brunner, E. J.; Chandola, T.; Marmot, M. G. (February 19, 2007). "Prospective Effect of Job Strain on General and Central Obesity in the Whitehall II Study". American Journal of Epidemiology. 165 (7): 828–837. doi: 10.1093/aje/kwk058 . PMID   17244635.
• Bulled, Nicola; Singer, Merrill (October 2011). "Syringe-Mediated Syndemics". AIDS and Behavior. 15 (7): 1539–1545. doi:10.1007/s10461-009-9631-1. PMID   19885727. S2CID   25317922.
• "Portrait of a Killer". Science. January 17, 2007.
• Chaulk, C. Patrick; Kazandjian, Vahé A. (September 2004). "Moving Beyond Randomized Controlled Trials". American Journal of Public Health. 94 (9): 1476. doi:10.2105/ajph.94.9.1476. PMC   1448474 . PMID   15333296.
• Cohen, Craig R.; Duerr, Ann; Pruithithada, Niwat; Rugpao, Sungwal; Garcia, Patricia; Nelson, Kenrad; Hillier, Sharon (September 1995). "Bacterial vaginosis and HIV seroprevalence among female commercial sex workers in Chiang Mai, Thailand". AIDS. 9 (9): 1093–1098. doi:10.1097/00002030-199509000-00017. PMID   8527084. S2CID   25056144.
• Chu, P., Santos, G.-M., Vu, A., Nieves-Rivera, G., Colfax, J., Grinsdale, S., Huang, S., Phillip, S., Scheer, S. and Aragon, T. 2012 Impact of syndemics on people living with HIV in San Francisco. Presented at the XIX International AIDS Conference, Washington, D.C. (MOACO202 Oral Abstract).
• Conant, Katelyn L.; Kaleeba, Johnan A. R.; Kaleeba, JA (2013). "Dangerous liaisons: molecular basis for a syndemic relationship between Kaposi's sarcoma and P. falciparum malaria". Frontiers in Microbiology. 4: 35. doi: 10.3389/fmicb.2013.00035 . PMC   3594938 . PMID   23487416.
• Corrêa-Oliveira, Rodrigo; Golgher, Denise B; Oliveira, Guilherme C; Carvalho, Omar S; Massara, Cristiano L; Caldas, Iramaya R; Colley, Daniel G; Gazzinelli, Giovanni (August 2002). "Infection with Schistosoma mansoni correlates with altered immune responses to Ascaris lumbricoides and hookworm". Acta Tropica. 83 (2): 123–132. doi:10.1016/s0001-706x(02)00108-0. PMID   12088853.
• Cui Yang; Koblin Beryl (2011). "Migration, Neighborhoods, and Networks: Approaches to Understanding How Urban Environmental Conditions Affect Syndemic Adverse Health Outcomes Among Gay, Bisexual and Other Men Who Have Sex With Men". AIDS and Behavior. 15 (Suppl 1): S35–S50. doi:10.1007/s10461-011-9902-5. PMC   3084486 . PMID   21369730.
• Daftary A (2012). "HIV and tuberculosis: The construction and management of double stigma". Social Science & Medicine. 74 (10): 1512–19. doi:10.1016/j.socscimed.2012.01.027. PMID   22444460.
• Daftary A.; Padayatchi N. (2012). "Social constraints to TB/HIV healthcare: Accounts from coinfected patients in South Africa". AIDS Care. 24 (12): 1480–86. doi:10.1080/09540121.2012.672719. PMC   3484188 . PMID   22530855.
• Santis De, Joseph Layerla, Dennys Barroso, Susana Gattamorta, Karina Sanchez, Michael, Prado Guillermo (2012). "Predictors of Eating Attitudes and Behaviors Among Gay Hispanic Men". Archives of Nursing. 26 (2): 111–126. doi:10.1016/j.apnu.2011.06.003. PMID   22449559.
• Dyer T.; Shoptaw S.; Guadamuz T.; Plankey M.; Kao U.; Ostrow D.; Chmiel J.; Herrick A.; Stall R. (2012). "Application of Syndemic Theory to Black Men Who Have Sex with Men in the Multicenter AIDS Cohort Study". Journal of Urban Health. 89 (4): 697–708. doi:10.1007/s11524-012-9674-x. PMC   3535137 . PMID   22383094.
• Dyer TV, Turpin RE, Stall R, Khan MR, Nelson LE, Brewer R, Friedman MR, Mimiaga MJ, Cook RL, OʼCleirigh C, Mayer KH. Latent Profile Analysis of a Syndemic of Vulnerability Factors on Incident Sexually Transmitted Infection in a Cohort of Black Men Who Have Sex With Men Only and Black Men Who Have Sex With Men and Women in the HIV Prevention Trials Network 061 Study. Sex Transm Dis. 2020 Sep;47(9):571-579. doi: 10.1097/OLQ.0000000000001208. PMID 32496390; PMCID: PMC7442627
• Easton, Delia 2004 The Urban Poor: Health Issues. Encyclopedia of Medical Anthropology, Volume 1, pp. 207–13. New York: Kluwer Academic/Plenum Publishers.
• Edberg Mark; Cleary Sean; Vyas Amita (2010). "A Trajectory Model for Understanding and Assessing Health Disparities in Immigrant/Refugee Communities". Immigration and Minority Health. 13 (3): 576–84. doi:10.1007/s10903-010-9337-5. PMID   20306225. S2CID   25923475.
• Engel Jeffery (2007). "Pandemic Influenza: The Critical Issues and North Carolina's Preparedness Plan". North Carolina Medical Journal. 68 (1): 32–37. doi: 10.18043/ncm.68.1.32 . PMID   17500429.
• Ezeamama A.; McGarvey S.; Acosta L.; Zierler S.; Manalo D.; Wu H-W.; Kurtis J.; Mor V.; Remigio O.; Friedman J. (2008). "The Synergistic Effect of Concomitant Schistosomiasis, Hookworm, and Trichuris Infections on Children's Anemia Burden". PLOS Neglected Tropical Diseases. 2 (6): e245. doi: 10.1371/journal.pntd.0000245 . PMC   2390851 . PMID   18523547.
• Fama Rosemary, Rosenbloom Margaret, Nichols Pfefferbaum, Nolan B., Adolf Sullivan, Edith (2009). "Working and Episodic Memory in HIV Infection, Alcoholism, and Their Comorbidity: Baseline and 1-Year Follow-Up Examinations". Alcoholism: Clinical and Experimental Research. 33 (10): 1815–25. doi:10.1111/j.1530-0277.2009.01020.x. PMC   2832705 . PMID   19656122.
• Fasula Amy; Miller Kim; Sutton Madeline (2009). "An early warning sign: sexually transmissible infections among young African American women and the need for preemptive, combination HIV prevention". Sexual Health. 6 (4): 261–63. doi: 10.1071/sh09084 . PMID   20157941.
• Ferlatte Oliver, Hottes Travis, Trussler Terry, Marchand Rick (2013). "Evidence of a Syndemic Among Young Canadian Gay and Bisexual Men: Uncovering the Associations Between Anti-gay Experiences, Psychosocial Issues, and HIV Risk". AIDS and Behavior. 18 (7): 1256–1263. doi: 10.1007/s10461-013-0639-1 . PMID   24129844. S2CID   23665615.
• Fleming F., Brooker S., Geiger S., Caldas I., Correa-Oliveira R., Hotez P., Bethony (2006). "Synergistic associations between hookworm and other helminth species in a rural community in Brazil". Tropical Medicine and International Health. 11 (1): 56–64. doi:10.1111/j.1365-3156.2005.01541.x. PMID   16398756. S2CID   20407618.
• Florey Lia, King Charles, Dyke Van, Melissa Muchiri, Eric Mungai, Peter Zimmerman, Peter, Wilson Mark (2012). "Partnering Parasites: Evidence of Synergism between Heavy Schistosoma haematobium and Plasmodium Species Infections in Kenyan Children". PLOS Neglected Tropical Diseases. 6 (7): e1723. doi: 10.1371/journal.pntd.0001723 . PMC   3404100 . PMID   22848765.
• Fiorella Kathryn (2013). "Considering the Complexity in HIV/AIDS and the Environment". American Journal of Public Health. 103 (9): e1. doi:10.2105/ajph.2013.301433. PMC   3780688 . PMID   23865670.
• Friedman Kutz, Reuel M., Steven Buttram, Mance Wei, Chongyi Silvestre, Anthony , Stall Ron (2013). "HIV Risk Among Substance-Using Men Who Have Sex with Men and Women (MSMW): Findings from South Florida". AIDS and Behavior.
• Garcia J.; Hromi-Fiedler A.; Mazur R.; Marquis G.; Sellen D.; Lartey A; Pérez-Escamilla R. (2013). "Persistent household food insecurity, HIV, and maternal stress in Peri-Urban Ghana". BMC Public Health. 13: 215. doi: 10.1186/1471-2458-13-215 . PMC   3608015 . PMID   23497026.
• Geldmacher C.; Zumla A.; Hoelscher M. (2012). "Interaction between HIV and Mycobacterium tuberculosis: HIV-1-induced CD4 T-cell depletion and the development of active tuberculosis". Current Opinion in HIV and AIDS. 7 (3): 268–74. doi:10.1097/coh.0b013e3283524e32. PMID   22495739. S2CID   20581401.
• Gerberding J (2005). "Protecting Health – The New Research Imperative". Journal of the American Medical Association. 294 (11): 1403–06. doi:10.1001/jama.294.11.1403. PMID   16174702.
• Gerns Helen; Sangare Laura; Walson Judd (2012). "Integration of Deworming into HIV Care and Treatment: A Neglected Opportunity". PLOS Neglected Tropical Diseases. 6 (7): e1738. doi: 10.1371/journal.pntd.0001738 . PMC   3409108 . PMID   22860143.
• Getahun Haileyesus; Raviglione Mario; Varma Jay; Cain Kevin; Samandari Taraz; Popovic Tanja; Frieden Thomas (2012). "CDC Grand Rounds: the TB/HIV Syndemic". Morbidity and Mortality Weekly Report. 61 (26): 484–89. PMID   22763886.
• Gielen A.; Ghandour R.; Burke J.; Mahoney P.; McDonnell K.; O'Campo P. (2007). "HIV/AIDS and Intimate Partner Violence: Intersecting Women's Health Issues in the United States". Trauma, Violence and Abuse. 8 (2): 179–98. doi:10.1177/1524838007301476. PMID   17545573. S2CID   38787483.
• González-Guarda Rosa (2009). "The Syndemic Orientation: Implications for Eliminating Hispanic Health Disparities". Hispanic Health Care International. 7 (3): 114–15. doi:10.1891/1540-4153.7.3.114.
• Gilbert, Louisa, Primbetova, Sholpan, Nikitin, Danil, Hunt, Timothy, Terlikbayeva, Assel, Momenghalibaf, Azzi, Murodali, Ruziev and El-Bassel, Nabila 2013 Redressing the epidemics of opioid overdose and HIV among people who inject drugs in Central Asia: The need for a syndemic approach. Drug and Alcohol Dependence (in press).
• González-Guarda Rosa; Florom-Smith A.; Thomas T. (2011). "A syndemic model of substance abuse, intimate partner violence, HIV infection, and mental health among Hispanics". Public Health Nursing. 28 (4): 366–78. doi:10.1111/j.1525-1446.2010.00928.x. PMC   3137267 . PMID   21736615.
• González-Guarda Rosa; McCabe B.; Florom-Smith A.; Cianelli R.; Peragallo N. (2011). "Substance Abuse, Violence, HIV, and Depression: An Underlying Syndemic Factor Among Latinas". Nursing Research. 60 (3): 182–89. doi:10.1097/nnr.0b013e318216d5f4. PMC   3171180 . PMID   21522030.
• González-Guarda Rosa, Santis De, Joseph, Vasquuez Elias (2013). "Sexual orientation and demographic, cultural and psychological factors associated with the perpetration and victimization of intimate partner violence among Hispanic men". Issues in Mental Health Nursing. 34 (2): 103–09. doi:10.3109/01612840.2012.728280. PMC   3563281 . PMID   23369121.
• Gonzalez-Guarda, Rosa M.; McCabe, Brian E.; Vermeesch, Amber L.; Cianelli, Rosina; Florom-Smith, Aubrey L.; Peragallo, Nilda (2013). "Cultural Phenomena and the Syndemic Factor: Substance Abuse, Violence, HIV, and Depression Among Hispanic Women". Annals of Anthropological Practice. 36 (2): 212–31. doi:10.1111/napa.12001. PMC   3932986 . PMID   24575326.
• González-Guarda Rosa; et al. (2013). "Pushing the Syndemic Research Agenda Forward: a Comment on Pitpitan et al.". Annals of Behavioral Medicine. 45 (2): 135–36. doi:10.1007/s12160-012-9464-4. PMC   3820103 . PMID   23355115.
• Grund Jean-Paul; Latypov Alisher; Harris Magdalena (2012). "Breaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia". International Journal of Drug Policy. 24 (4): 265–74. doi:10.1016/j.drugpo.2013.04.007. PMID   23726898.
• Guadamuz, Thomas, Friedman, Mark, Marshal, Michael, Herrick, Amy, Lim, Sin How, Wei, Chongyi, and Stall, Ron 2013 Health, Sexual Health, and Syndemics: Toward a Better Approach to STI and HIV Preventive Interventions for Men Who Have Sex with Men (MSM) in the United States. In S. Aral, K. Fenton, J. Lipshuz, Eds. The New Public Health and STD/HIV Prevention: Personal, Public and Health Systems Approaches. New York: Springer Sciences and Business Media.
• Guadamuz T.E., McCarthy K., Wimonsate W., Thienkrua W., Varangrat A., Chaikummao S., Sangiamkittikul A., Stall R.D., van Griensven F. (2014). "Psychosocial Health Conditions and HIV Prevalence and Incidence in a Cohort of Men Who have Sex with Men in Bangkok, Thailand: Evidence of a Syndemic Effect". AIDS and Behavior. 18 (11): 2089–2096. doi:10.1007/s10461-014-0826-8. PMC   4198419 . PMID   24989128.
• Halkitis P.; Moeller R.; Siconolfi D.; Storholm E.; Solomon T.; Bub K. (2012). "Measurement Model Exploring a Syndemic in Emerging Adult Gay and Bisexual Men". AIDS and Behavior. 17 (2): 662–73. doi:10.1007/s10461-012-0273-3. PMC   3675898 . PMID   22843250.
• Halkitis Perry; Kupprat Sandra; Hampton Melvin; Perez-Figueroa Rafael; Kindon Molly; Eddy Jessica; Ompad Danielle (2013). "Evidence for a Syndemic in Aging HIV-Positive Gay, Bisexual, and Other MSM: Implications for a Holistic Approach to Prevention and Health Care". Annals of Anthropological Practice. 36 (2): 363–84. doi:10.1111/napa.12009. PMC   3859453 . PMID   24347817.
• Hardin Amy; Crandall Philip; Stankus Tony (2011). "The Zoonotic Tuberculosis Syndemic: A Literature Review and Analysis of the Scientific Journals Covering a Multidisciplinary Field That Includes Clinical Medicine, Animal Science, Wildlife Management, Bacterial Evolution, and Food Safety". Science & Technology Libraries. 30 (1): 20–57. doi:10.1080/0194262x.2010.523666. S2CID   72925288.
• Hein, Casey and Small, Doreen 2007 Combating Diabetes, Obesity, Periodontal Disease and Interrelated Inflammatory Conditions with a Syndemic Approach.
• Herrick Amy; Lim Sin; Wei Chongyi; Smith Helen; Guadamuz Thomas; Friedman Mark; Stall Ron (2011). "Resilience as an Untapped Resource in Behavioral Intervention Design for Gay Men". AIDS and Behavior. 15 (Suppl 1): S25–S29. doi: 10.1007/s10461-011-9895-0 . PMID   21344306. S2CID   5928863.
• Herrick Amy; Lim Sin; Plankey Michael; Chmiel Joan; Guadamuz Thomas; Kao Uyen; Shoptaw Steven; Carrico Adam; Ostrow David; Stall Ron (2013). "Adversity and Syndemic Production Among Men Participating in the Multicenter AIDS Cohort Study: A Life-Course Approach". American Journal of Public Health. 103 (1): 79–85. doi:10.2105/ajph.2012.300810. PMC   3518355 . PMID   23153154.
• Herring, D Ann 2008 Viral Panic, Vulnerability and the Next Pandemic. In Health, Risk and Adversity, Catherine Panter-Brick and Agustín Fuentes, Eds, pp 78–100. Oxford, U.K.: Berghahn Books, 2008.
• Highet Megan (2010). "It Depends on Where You Look": The Unusual Presentation of Scurvy and Smallpox Among Klondike Gold Rushers as Revealed Through Qualitative Data Sources". Past Imperfect: The History and Classics Graduate Student Journal. 16: 3–34.
• Himmelgreen David; Romero-Daza Nancy; Turkon David; Watson Sharon; Okello-Uma Ipolto; Sellen Daniel (2009). "Addressing the HIV/AIDS-food insecurity syndemic in sub-Saharan Africa". African Journal of AIDS Research. 8 (4): 401–12. doi:10.2989/ajar.2009.8.4.4.1041. PMID   25875704. S2CID   41159222.
• Himmelgreen, David and Romero-Daza, Nancy. Environment: Science and Policy for Sustainable Development "The Global Food Crisis, HIV/AIDS, and Home Gardens"\. Environment: Science and Policy for Sustainable Development June–July 2010.
• Himmelgreen David; Romero-Daza Nancy; Amador Edgar; Pace Cynthia (2013). "Tourism, Economic Insecurity, and Nutritional Health in Rural Costa Rica:Using Syndemic Theory to Understand the Impact of the Globalizing". Annals of Anthropological Practice. 36 (2): 344–62. doi:10.1111/napa.12008.
• Jain S, Oldenburg CE, Mimiaga MJ, Mayer KH. High Levels of Concomitant Behavioral Health Disorders Among Patients Presenting for HIV Non-occupational Post-exposure Prophylaxis at a Boston Community Health Center Between 1997 and 2013. AIDS Behav. 2016 Jul;20(7):1556-63. doi: 10.1007/s10461-015-1021-2. PMID 25689892; PMCID: PMC4540681
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• Singer Merrill; Erickson Pamela; Badiane Louise; Diaz Rosemary; Ortiz Dueidy; Abraham Traci; Nicolaysen Anna Marie (2006). "Syndemics, Sex and the City: Understanding Sexually Transmitted Disease in Social and Cultural Context". Social Science and Medicine. 63 (8): 2010–21. doi:10.1016/j.socscimed.2006.05.012. PMC   7131051 . PMID   16782250.
• Singer, Merrill, Herring, D. Ann, Littleton, Judith, and Rock, Melanie 2011 Syndemics in Global Health. In A Companion to Medical Anthropology, Merrill Singer and Pamela I. Erickson, Editors, pp. 219–49. Malden, MA: Wiley-Blackwell.
• Singer Merrill; Snipes Charlene (1992). "Generations of Suffering: Experiences of a Pregnancy and Substance Abuse Treatment Program". Journal of Health Care for the Poor and Underserved. 3 (1): 235–39. doi:10.1353/hpu.2010.0852.
• Singer Merrill; Bulled Nicola; Ostrach Bayla (2013). "Syndemics and Human Health: Implications for Prevention and Intervention". Annals of Anthropological Practice. 36 (2): 205–11. doi:10.1111/napa.12000.
• Singer Merrill; Bulled Nicola (2013). "Interlocked Infections: The Health Burdens of Syndemics of Neglected Tropical Diseases". Annals of Anthropological Practice. 36 (2): 326–44. doi:10.1111/napa.12007.
• Southgate Erica, Weatherall Day, Marr Anne, Carolyn Dolan, Kate (2005). "What's in a Virus? Folk Understandings of Hepatitis C Infection and Infectiousness among Injecting Drug users in Kings Cross, Sydney". International Journal for Equity in Health. 4 (1): 5. doi: 10.1186/1475-9276-4-5 . PMC   1079912 . PMID   15788093.
• Specter, Michael 2005 Higher Risk: Crystal Meth, the Internet, and dangerous Choices about AIDS. The New Yorker, May 23, pp. 39–45.
• Stall, Ron 2007 "An Update on Syndemic Theory Among Urban Gay Men" Archived May 10, 2009, at the Wayback Machine . Presented at the American Public Health Association meetings, Washington, DC. Abstract #155854.
• Stall, Ron, Friedman, M.S., and Catania, J. 2007 Interacting Epidemics and Gay Men's Health: A theory of Syndemic Production among Urban Gay Men. In Unequal Opportunity: Health Disparities Affecting Gay and Bisexual Men in the United States, Richard J. Wolitski, Ron Stall, and Ronald O. Valdiserri (Eds). Oxford: Oxford University Press.
• Stall, Ron, Friedman, M.S., Kurz, M. and Buttram, M.. "2012 Syndemic associations of HIV risk among sex-working MSM in Miami and Ft. Lauderdale, USA". Presented at the XIX International AIDS Conference, Washington, D.C. (MOPE328, Poster exhibit).
• Stall Ron; Mills Thomas; Williamson J.; Hart T. (2003). "Association of Co-occurring Psychosocial Health Problems and Increased Vulnerability to HIV/AIDS Among Urban men who have Sex with Men". American Journal of Public Health. 93 (6): 939–42. doi:10.2105/ajph.93.6.939. PMC   1447874 . PMID   12773359.
• Stall, Ron and Mills, Thomas 2006 "Health Disparities, Syndemics and Gay Men's Health" Archived March 8, 2008, at the Wayback Machine . Presented at the Center for Health Intervention and Prevention. University of Connecticut.
• Stall, Ron and van Griensven, Frits 2005 New Directions in Research Regarding Prevention for Positive Individuals: Questions Raised by the Seropositive Urban Men's Intervention Trial. AIDS 19 Supplement 1: S123–27.
• Stephens, Christianne V. 2008 "She was Weakly for a Long time and the Consumption Set" In Using Parish Records to Explore Disease Patterns and Causes of Death In a First Nations Community. Research in Anthropology and Linguistics (RAL-e) Monograph Series. Ann Herring, Judith Littleton, Julie Park and Tracy Farmer (eds.) No. 3 134–48.
• Stephens, Christianne V. 2009 Syndemics, Structural Violence and the Politics of Health: A Critical Biocultural Approach to the Study of Disease and Tuberculosis Mortality in a Parish Population at Walpole Island (1850–1885). In Proceedings of the 39th Annual Algonquian Conference. Vol. 39 581–613. Karl Hele, (ed). London: University of Western Ontario.
• Storholm E., Halkitis P., Siconolfi D., Moeller R. (2011). "Cigarette Smoking as Part of a Syndemic among Young Men Who Have Sex with Men Ages 13–29 in New York City". Journal of Urban Health. 88 (4): 663–76. doi:10.1007/s11524-011-9563-8. PMC   3157504 . PMID   21479753.
• Talman Anna; Bolton Susan; Walson Judd (2012). "Interactions Between HIV/AIDS and the Environment: Toward a Syndemic Framework". American Journal of Public Health. 103 (2): 253–61. doi:10.2105/ajph.2012.300924. PMC   3558758 . PMID   23237167.
• Tezal Mine (2012). "Interaction between Chronic Inflammation and Oral HPV Infection in the Etiology of Head and Neck Cancers". International Journal of Otolaryngology. 2012: 575242. doi: 10.1155/2012/575242 . PMC   3299260 . PMID   22518158.
• Tian Li-Guang; Wang Tian-ping; Lv Shan; Wang Feng-Feng; Guo Jian; Yin Xiao-Mei; Cai Yu-Chun; Dickey Mary; Steinmann Peter; Chen Jia-Xu (2013). "HIV and intestinal parasite co-infections among a Chinese population: an immunological profile". Infectious Diseases of Poverty. 2 (1): 18. doi: 10.1186/2049-9957-2-18 . PMC   3766051 . PMID   23971713.
• Tieu Van; Koblin B (2009). "HIV, Alcohol, and Noninjection Drug Use". Current Opinion in HIV and AIDS. 4 (4): 314–18. doi:10.1097/coh.0b013e32832aa902. PMID   19532070. S2CID   27956703.
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External links

• Syndemic Prevention Network: Home
• Merrill Singer (October 2008). "The Perfect Epidemiological Storm: food insecurity, HiV/aids and Poverty in southern africa" (PDF). In Focus. Archived from the original (PDF) on June 7, 2011.
• Wayback Machine
• Jack Homer; Bobby Milstein (April 2003). "A Dynamic Simulation Model of Syndemics: Casual Structure, Assumptions, and Results" (PDF). Centers for Disease Control and Prevention. Archived from the original (PDF) on August 5, 2019. Retrieved December 10, 2007.