Characterization and Correlates of the Substance Use, Violence, HIV/AIDS (SAVA) Syndemic Among Transgender and Gender Non-Conforming (TGNC) Individuals: Results from the Virginia Transgender Health Initiative Study

Introduction: Transgender and Gender Non-Conforming (TGNC) individuals endure exorbitant rates of substance use, HIV risk, and physical and sexual violence (SAVA); however, the impact of these conditions and the application of syndemic theory in this population remain underexplored. Characterizing and exploring the SAVA syndemic presents significant public health and clinical practice implications.

Methods: This study’s analytic sample (N=192) was derived from the 2005-06 Virginia Transgender Health Initiative Study to assess the prevalence of syndemic conditions and sociodemographic correlates. Unadjusted analyses were conducted to explore the associations between sociodemographic characteristics (e.g., education, income, homelessness) and syndemic conditions (illicit drug use, physical and sexual violence as well as HIV status) among TGNC individuals.

Results: The majority of participants identified as transgender (76%) and were between the ages of 18 and 35 (53.1%). Of 192 participants, 40.1% identified as Non-White, 25% had an education level of High School or less, 64.3% reported an individual income of $30,000 or less and 26.5% reported ever being homelessness. In terms of syndemic conditions, 55.7% endorsed illicit drug use, 47.9% had experienced some form of violence and 35.4% were HIV positive or unaware of their status. The odds of experiencing syndemic conditions were greater among those with high school education or less (OR=9.43; CI 1.16-76.61) relative to individuals with a college degree or above. Higher odds of experiencing syndemic conditions was higher among individuals whose income was up to $9,999 (OR=3.6; CI 1.12-11.57) and between $10,000 and $29,999 (OR=5.65; CI 1.55-20.58) compared to those whose income was $30,000 or more. Those who had experienced homelessness also had a higher likelihood of endorsing syndemic conditions (OR=8.07; CI 1.05-61.87). Increased odds of endorsing syndemic conditions was associated with reporting a prior suicide attempt (OR=8.63; CI 1.06-70.09).

Conclusions: Results from these analyses highlight the prevalence of syndemic conditions that may synergistically contribute to the excessive burden of preventable diseases. Furthermore, the results underscore the necessity for further investigation of syndemics and their impact as well as warrants tailored interventions focused on their adverse outcomes.