Syndemics centre stage at OHTN Conference, (“But what are syndemics?” I hear you say)
Bob Leahy was at the Ontario HIV Treatment Network Endgame conference this week where the role of inter-related factors that affect HIV transmission and treatment were the topic.
OHTN board chair Tony DiPede opening the conference
Before Ron Stall, a Pittsburgh academic, promoted the term “syndemics”, it was hardly on the HIV health sector’s radar. Now it most definitely is, particularly on that of those who work in gay men’s sexual health. Its latter day influence is remarkable. Thus in 2016 we see prominent HIV conferences like this week's in Toronto, held in downtown’s venerable King Edward Hotel, entirely devoted to it.
So to backtrack, what are syndemics? To quote a description of his work “Dr. Stall has become interested in the combined effects of multiple psychosocial epidemics, or “syndemics” in driving HIV risk . . how structural factors increase the prevalence of syndemic conditions among gay men and their relationship to the development of psychosocial health problems and how the study of syndemics might be used to inform combination HIV prevention models.”
Still confused? Here’s how Wikipedia defines it: “A syndemic is the aggregation of two or more diseases in a population in which there is some level of positive biological interaction that exacerbates the negative health effects of any or all of the diseases.”
Even simpler? It’s a bunch of life factors working with each other to make it worse for the susceptible. For those who work in the field, knowing about syndemics helps to provide a stronger response to addressing HIV transmission risk in the community. Systemic problems like untreated mental health issues, addictions, heterosexism, social isolation, poverty are typical culprits, but the list can be extensive.
The impact is that it makes it a more difficult proposition to get the HIV epidemic under control, As if to illustrate just this, the conference opened with a review of Ontario HIV’s latest new HIV infection numbers; the last two years show a rising trend after a period of relative stability. (Some might argue this reflects deliberately ramped-up testing producing and thus more positive test results. Who knows?)
Meanwhile treatment cascade data, briefly shared at the conference opening, seems to indicate we have a long way to go here in Ontario, with only 60% (?) of those who know that they are positive having an undetectable viral load. Within that context efforts to reach 90-90-90 by 2020 would seem to provide Ontario with an ongoing challenge. (How is Canada as a whole doing? We just don’t know. But expect to see more on December 1, World AIDS Day.)
That’s not to say Ontario doesn’t have some good data on other aspects of what life looks like for people living with HIV within the province. We are privileged to have The Ontario Cohort Study, an almost 5,000 strong subset of people living with HIV in the Province, including myself, whose progress is followed in some detail. Thus we know 28.5% of us experience depression, 27% have hazardous alcohol use issues, 40% smoke cigarettes, 57% people get by on under $20,000 a year, 25% have a history of trauma and 50% have to deal with housing instability. Why is this important? We know that a higher incidence of syndemic factors like this leads to increased risk behavior, but also complicates, once diagnosed, engagement in the health care system and ultimately, in adhering to treatment and attaining an undetectable viral load.
That, in broad strokes is what the conference addressed very well in dozens of sessions, even extending to the impact of art, film making and performance. Some of that material will appear online in due course, so I will not go into individual session content. I will say that the OHTN is good - very good - at this kind of thing, bringing in speakers both Canadian and from around the world, often outstanding in their field. The OHTN also works hard to make this a community dialogue, bringing in dozens of people living with HIV by way of scholarships that cover their travel and accommodation. Not only that the OHTN ensures the experience is intelligible, even for conference newbies. It’s an exemplary process.
There was some sadness too, a chance to acknowledge those no longer with us. Because this year has been marked by too many deaths of those well known in the community, this year’s conference was dedicated to “the peer research associates we have lost over the past months - and to all peer research assistants.” Positive Lite.com social media guru Wayne Bristow is one such associate who fortunately is still with us.
For those people living with HIV not so far connected and who live in Ontario, I’d encourage you to apply next time the scholarship application process rolls around. We will post a link to it on our site. If you are connected to an AIDS Service Organization make sure they are committed to keeping people living with HIV informed of opportunities to attend these kind of events free of charge.
Not that for those attending, it doesn’t raise issues of privilege which it behooves each of us to acknowledge. For those of us, like myself, coming from out of town, we stayed at the conference host hotel, the swanky King Edward (left) in downtown Toronto. We were fed in the manner grand hotels like this feed their guests. We slept on beautiful linens. Understand there are very practical reasons why conferences like this are not held at out-of-the-way budget hotels. But not acknowledging the privilege of being there, and treated very well in the process, isn’t doing the right thing.
So here is a very public thank you to the OHTN for including so many people living with HIV in the process and providing a unique learning opportunity they and we should be proud of.