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115 1 beyond behaviours minority stress
1. Syndemics Do Not ComeSyndemics Do Not Come
Out of a Vaccuum: LessonsOut of a Vaccuum: Lessons
Learned from ResearchLearned from Research
Dr. Trevor A. Hart
Associate Professor
Department of Psychology
Ryerson University
2. Syndemics: DefinitionSyndemics: Definition
(Singer, 1996; 2006)(Singer, 1996; 2006)
Comes out of sociology
◦ Syn = working together
◦ Demos = people
“A set of closely intertwined and mutual enhancing
health problems that significantly affect the overall
health status of a population within the context of a
perpetuating configuration of noxious social
conditions.” (p. 99)
Originally studied among Puerto Rican community in
Hartford, CT
Concern that problems were often looked at in
isolation from each other
Examines social context (e.g., migration, poverty,
racism, marginalization)
4. Examples of SyndemicsExamples of Syndemics
SAVA syndemic (substance abuse,
violence and AIDS) (Singer, 1996)
Hookworm, malaria and HIV/AIDS
syndemic (Hotez, 2003)
Malnutrition and depression syndemic
(Heflin, Siefert, & Williams, 2005)
Mental health and HIV/AIDS syndemic
(Stall et al., 2003)
5. Confluence of Psychosocial RisksConfluence of Psychosocial Risks
(Stall, Mills, Williamson, Hart, et al., 2003)(Stall, Mills, Williamson, Hart, et al., 2003)
2881 gay and bisexual male participants
Examined depression, childhood sexual
abuse, partner violence, and multiple drug
use
The more of these psychological problems
you have, the:
◦ Higher the risk of unprotected intercourse
◦ Higher the chances of being HIV+
6. Confluence of PsychologicalConfluence of Psychological
RisksRisks
0
10
20
30
0 1 2 3
Unprotected Sex
HIV-Positive
Similar findings among heterosexual
women (Cohen et al., 2000)
This suggests that interventions to reduce
HIV risk should include interventions to
reduce psychological problems
7. What Minority Stress ModelsWhat Minority Stress Models
Tell Us About Health DisparitiesTell Us About Health Disparities
12. Solving the ProblemSolving the Problem
LGBTQ
Equitable
Health Access
Pride and Anti-
Homophobic
Messaging for
Gay Men
Anti-
Homophobia
Education and
Legislation
13. Solving the ProblemSolving the Problem
LGBTQ
Equitable
Health Access
Pride and Anti-
Homophobic
Messaging for
Gay Men
Anti-
Homophobia
Education and
Legislation
Canadian Human
Rights Code
Planned Parenthood’s
T.E.A.C.H. Program
14. Solving the ProblemSolving the Problem
LGBTQ
Equitable
Health Access
Pride and Anti-
Homophobic
Messaging for
Gay Men
Anti-
Homophobia
Education and
Legislation
Canadian Human
Rights Code
Planned Parenthood’s
T.E.A.C.H. Program
15. Solving the ProblemSolving the Problem
LGBTQ
Equitable
Health Access
Pride and Anti-
Homophobic
Messaging for
Gay Men
Anti-
Homophobia
Education and
Legislation
Canadian Human
Rights Code
Planned Parenthood’s
T.E.A.C.H. Program
CBRC’s Totally
Outright Program,
GSA’s
16. Solving the ProblemSolving the Problem
LGBTQ
Equitable
Health Access
Pride and Anti-
Homophobic
Messaging for
Gay Men
Anti-
Homophobia
Education and
Legislation
Canadian Human
Rights Code
Planned Parenthood’s
T.E.A.C.H. Program
CBRC’s Totally
Outright Program,
GSA’s
17. Solving the ProblemSolving the Problem
LGBTQ
Equitable
Health Access
Pride and Anti-
Homophobic
Messaging for
Gay Men
Anti-
Homophobia
Education and
Legislation
Canadian Human
Rights Code
Planned Parenthood’s
T.E.A.C.H. Program
CBRC’s Totally
Outright Program,
GSA’s
Rainbow Health
Ontario, Gay Poz
Sex, Sexual
Confidence Program
Notas do Editor
Syndemics Do Not Come Out of a Vaccum Dr. Trevor Hart, Department of Psychology, Ryerson University Syndemic models have allowed for an understanding of how gay and bisexual men are at risk for a multitude of health problems. The Minority Stress Model and the related Psychological Mediation Framework add depth to the syndemic model by explaining why and how gay and bisexual men experience these multiple health problems. Dr. Hart will review the available literature and will add his own recent findings explaining how health behaviours occur in the context of a discriminatory environment. Dr. Hart will also discuss the strengths and limitations of these models, especially regarding the resilience of gay and bisexual men.
Various syndemics (although not always labeled as such) have been described in the literature already, including the SAVA syndemic (substance abuse, violence and AIDS) (Singer, 1996), the hookworm, malaria and HIV/AIDS syndemic (Hotez, 2003), the Chagas disease, rheumatic heart disease and congestive heart failure syndemic (Cubillos-Garzon, Casas, Morillo, & Bautista, 2004), the asthma and infectious disease syndemic (Johnson & Martin, 2005), the malnutrition and depression syndemic (Heflin, Siefert, & Williams, 2005), and the mental health and HIV/AIDS syndemic (Stall et al., 2003). Additionally, several syndemics have been identified that involve STDs (Chesson, Heffelfinger, Voigt, & Collins, 2005; Craib, Meddings, & Strathdee, 1995; Otten, Zaidi, Peterman, Rolfs, & Witte, 1994). Here too, researchers report interactions between comorbid STDs and other diseases (Nusbaum, Wallace, Slatt, & Kondrad, 2004).
Various syndemics (although not always labeled as such) have been described in the literature already, including the SAVA syndemic (substance abuse, violence and AIDS) (Singer, 1996), the hookworm, malaria and HIV/AIDS syndemic (Hotez, 2003), the Chagas disease, rheumatic heart disease and congestive heart failure syndemic (Cubillos-Garzon, Casas, Morillo, & Bautista, 2004), the asthma and infectious disease syndemic (Johnson & Martin, 2005), the malnutrition and depression syndemic (Heflin, Siefert, & Williams, 2005), and the mental health and HIV/AIDS syndemic (Stall et al., 2003). Additionally, several syndemics have been identified that involve STDs (Chesson, Heffelfinger, Voigt, & Collins, 2005; Craib, Meddings, & Strathdee, 1995; Otten, Zaidi, Peterman, Rolfs, & Witte, 1994). Here too, researchers report interactions between comorbid STDs and other diseases (Nusbaum, Wallace, Slatt, & Kondrad, 2004).
All of these psychological problems predicted each other (with the exception of childhood sexual abuse and multiple drug use)
Similar findings among heterosexual women (Cohen et. al, 2000) in AJPH, with CSA, domestic violence, and lifetime drug use being correlated with each other, AND all of these being associated with HIV risk behaviors (e.g., lifetime # of male sex partners, ever forced to have sex with HIV+ partner)
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.
Hatzenbuehler, M. (2009). How Does Sexual Minority Stigma “Get Under the Skin”? A Psychological Mediation Framework. Psychological Bulletin, 135, 707-730.
Canadian Human Rights Act. [8] Section 3 of the Act prohibits discrimination based on "race, national or ethnic origin, colour, religion, age, sex, sexual orientation, marital status, family status, disability and conviction for which a pardon has been granted." Section 13(1) addresses the issue of hate (1977) Planned Parenthood Toronto - The T.E.A.C.H. peer education workshop involves trained peer facilitators leading interactive activities and sharing personal stories to encourage workshop participants to think critically about homophobia and heterosexism. Our facilitators are between the ages of 16 and 22, and come from a wide range of backgrounds. T.E.A.C.H. workshops challenge negative assumptions about gays, lesbians, bisexuals, and transgender people and show how these assumptions can lead to homophobic violence and hate crimes.
Canadian Human Rights Act. [8] Section 3 of the Act prohibits discrimination based on "race, national or ethnic origin, colour, religion, age, sex, sexual orientation, marital status, family status, disability and conviction for which a pardon has been granted." Section 13(1) addresses the issue of hate (1977) Planned Parenthood Toronto - The T.E.A.C.H. peer education workshop involves trained peer facilitators leading interactive activities and sharing personal stories to encourage workshop participants to think critically about homophobia and heterosexism. Our facilitators are between the ages of 16 and 22, and come from a wide range of backgrounds. T.E.A.C.H. workshops challenge negative assumptions about gays, lesbians, bisexuals, and transgender people and show how these assumptions can lead to homophobic violence and hate crimes.
Canadian Human Rights Act. [8] Section 3 of the Act prohibits discrimination based on "race, national or ethnic origin, colour, religion, age, sex, sexual orientation, marital status, family status, disability and conviction for which a pardon has been granted." Section 13(1) addresses the issue of hate (1977) Planned Parenthood Toronto - The T.E.A.C.H. peer education workshop involves trained peer facilitators leading interactive activities and sharing personal stories to encourage workshop participants to think critically about homophobia and heterosexism. Our facilitators are between the ages of 16 and 22, and come from a wide range of backgrounds. T.E.A.C.H. workshops challenge negative assumptions about gays, lesbians, bisexuals, and transgender people and show how these assumptions can lead to homophobic violence and hate crimes.
Canadian Human Rights Act. [8] Section 3 of the Act prohibits discrimination based on "race, national or ethnic origin, colour, religion, age, sex, sexual orientation, marital status, family status, disability and conviction for which a pardon has been granted." Section 13(1) addresses the issue of hate (1977) Planned Parenthood Toronto - The T.E.A.C.H. peer education workshop involves trained peer facilitators leading interactive activities and sharing personal stories to encourage workshop participants to think critically about homophobia and heterosexism. Our facilitators are between the ages of 16 and 22, and come from a wide range of backgrounds. T.E.A.C.H. workshops challenge negative assumptions about gays, lesbians, bisexuals, and transgender people and show how these assumptions can lead to homophobic violence and hate crimes.
LGBT cultural competency training is designed to assist service providers in their understanding of these issues and to improve their skills in providing health education, disease prevention, and treatment for lesbians, gay men, bisexual and trans people. Rainbow Health Ontario works in collaboration and partnership with other organizations, programs and individuals to provide a truly integrated LGBT framework of training and education.
