Syndemic

From Wikipedia, the free encyclopedia
Jump to: navigation, search

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. The term was developed and introduced by Merrill Singer in several articles in the mid-1990s and has since received growing attention and use among epidemiologists and medical anthropologists concerned with community health and the effects of social conditions on health, culminating in a recent textbook.[1] Syndemics tend to develop under conditions of health disparity, caused by poverty, stress, or structural violence, and contribute to a significant burden of disease in affected populations. The term syndemic is further reserved to label the consequential interactions between concurrent or sequential diseases in a population and in relation to the social conditions that cluster the diseases within the population.

The traditional biomedical approach to disease is characterized by an effort to diagnostically isolate, study, and treat diseases as if they were distinct entities that existed in nature separate from other diseases and independent of the social contexts in which they are found. This singular approach proved useful historically in focusing medical attention on the immediate causes and biological expressions of disease and contributed, as a result, to the emergence of targeted modern biomedical treatments for specific diseases, many of which have been successful. As knowledge about diseases has advanced, it is increasingly realized that diseases are not independent and that synergistic disease interactions are of considerable importance for prognosis. Given that social conditions can contribute to the clustering, form and progression of disease at the individual and population level, there is growing interest in the health sciences on syndemics.

Cooccurrence versus syndemism[edit]

Disease cooccurrence, with or without interactions, is known as comorbidity, coinfection and associated terms. The differences between "comorbid" and "syndemic" are not merely semantic. As Mustanski et al. (2008:40) explain: "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." Consequently, it is possible for two afflictions to be comorbid, but not be syndemic (i.e., the disorders are not epidemic in the studied population or their co-occurrence is not accompanied by worsened health). Thus, two (or more) diseases can be comorbid but no interaction occurs between them, while in other cases interaction occurs but it has beneficial rather than deleterious consequences. 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.

Types of disease interaction[edit]

Interest in the syndemics perspective has been driven by growing evidence of the regularity of interactions among diseases and recognition that this interaction influences disease course, expression, severity, transmission, and diffusion. Several different kinds of interaction among diseases have been described, including both indirect (changes caused by one disease that facilitate another through an intermediary) and direct interface (diseases act in direct tandem). In some syndemic interactions—such as the one between diabetes and SARS—changes in biochemistry or damage to organ systems caused by one disease (in this case, diabetes), such as weakening of the immune system, promotes the progression of another disease (SARS). This type of relationship also connects HIV infection and a host of "opportunistic" bacterial (e.g. mycobacterial (Mycobacterium tuberculosis, Mycobacterium avium), fungal (e.g. candidiasis), protozoal (e.g. toxoplasmosis), and viral (e.g. Human Papilloma Virus) infections and possibly viral-caused malignancies (Kaposi's Sarcoma). Similarly, there is evidence that periodontitis, which can lead to tooth loss, may arise from a syndemic. Periodontitis is known to be caused by bacteria of several different species (e.g., Porphyromonas gingivalis, Dialister pneumosintes, Prevotella intermedia) that adhere to and reproduce on tooth surfaces, especially under the gum line. Multiplication of these pathogens may be inhibited by bodily defenses unless these are weakened by a herpesvirus infection of the periodontium.

Another type of syndemic relationship involves one disease enhancing the virulence of another. There is evidence, for example, that herpesvirus has this effect on HIV infection, with progression to AIDS being significantly accelerated by co-infection with herpesvirus. Similarly, in gum infection, periodontal bacteria may enhance the virulence of herpesvirus. In addition, HIV-infected individuals are more susceptible to tuberculosis even though the cause is not fully understood.[2]

Alternately, one disease can assist the physical transmission of another disease. This appears to be the case, for example, with syphilis and HIV coinfection as a result of genital-tract ulceration caused by the former supporting sexual transmission of the latter.

Direct interaction of diseases is 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 of these 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 is the case among plant or some animal species but of significant potential concern as animal diseases adapt to human hosts—which they have been doing at an increasingly rapid pace—and as new diseases come into contact[citation needed].

In some cases, coinfection may open up multiple syndemic pathways. In studies of human populations, a lethal synergism has been identified between influenza virus and pneumococcus, a likely cause of excess mortality from secondary bacterial pneumonia during influenza epidemics. There is a significant level of evidence indicating that the influenza virus alters the lungs in ways that increase the adherence, invasion and induction of disease by pneumococcus. But other consequential changes, such as alteration of the immune response which weakens the body’s ability to clear pneumococcus (or, alternately, by amplifying the inflammatory cascade), are also suggested by existing research.

In other cases, syndemic interaction among diseases is apparent but the pathways of linkage are not yet clear. An example is the apparent interaction that occurs between type 2 diabetes mellitus and hepatitis C viral infection. Several factors are known to contribute to the onset of type 2 diabetes, including diet, obesity and aging. The role of infection, however, is only beginning to be understood. Already it is known that risk for serious infections of various kinds increase significantly with poor diabetes control, but appreciation of more complex relationships between infection and type 2 diabetes is now emerging as well.

Counter-syndemics[edit]

Discussion of deleterious disease interactions raises a question about the possibility of an opposite kind of disease interaction, namely: are there counter syndemics, disease interactions that lower the burden of disease in a population below the sum effects of the individual diseases involved? The discovery of counter-syndemics is important because such entities may suggest novel strategies for the prevention and treatment of disease. Recent research findings suggest that counter-syndemics do occur and are part of the complex world of co-morbidity. For example, William Moss and fellow researchers at the Johns Hopkins Bloomberg School of Public Health have found that human immunodeficiency virus is transiently suppressed during an acute measles infection. This finding was the product of a study of HIV-infected children living in Zambia. In the study, children who had measles, and reported various typical symptoms, including fever, rash, conjunctivitis, runny nose, and cough, had a significant drop in HIV levels detectable in the blood as compared to HIV-infected children who were not infected with measles. Several potential mechanisms could be responsible for the temporary suppression of HIV replication early in the course of a measles infection. Morbillivirus (measles virus) infection is known to cause lymphopenia, a reduction in the number of CD4+ T lymphocytes circulating in the blood. The low point in lymphocyte levels occurs just prior to the onset of the distinct red circular skin rash (called rubeola) characteristic of a measles infection. Within a month of this nadir, the number of lymphocytes tends to return to normal levels. The drop in HIV may reflect a decrease in target CD4+ T cells needed for replication. Alternately, measles virus infection may stimulate the production of cells that are directly responsible for suppressing HIV replication. Several candidates have been suggested, including the β-chemokines, CD8+ cell antiviral factor, and the cytokines known as IL-10 and IL-16 (biochemicals that inhibit HIV transcription), but none has been confirmed as the source of HIV suppression. Additionally, Moss and co-workers found that median plasma levels of RANTES, a chemokine that attracts immune system components like eosinophils (a kind of white blood cell that destroys parasitic organisms), monocytes (a precursor of macrophages), and lymphocytes, were higher in HIV-infected children with measles than in those without measles. HIV suppression also has been identified in patients suffering tsutsugamushi disease, a mite-borne infection found in Asia and Australia, also known as scrub typhus, although the how this occurs is not clear. Other counter-syndemics are likely to be discovered as a syndemic perspective emphazing paying attention to processes and relationships diffuses among researchers.

Iatrogenic syndemics[edit]

The term iatrogenesis means "brought forth by a healer" (iatro is the Greek word for healer) and almost always is used to refer to adverse health conditions caused by medical treatment (such as unwelcome side effects). Can there be iatrogenic syndemics? In principle, this is possible if medical treatment or medical research is involved in creating conditions that increase the likelihood that two or more diseases come together in a population. An example of this scenario would be the use of gene splicing to unite two pathogenic agents and introducing the resulting novel organism into a population. There is a possibility that this precise event occurred, for example, during a randomized, double-blind clinical trial testing the efficacy of the prototype HIV vaccine called V520. On November 6, 2007, the pharmaceutical manufacturer Merck & Co. announced that research on the drug had been stopped because interim findings showed that there appeared to be an increased risk for HIV infection among participants in the vaccine arm of the study compared to those in the placebo group. Specifically, results showed that of the 741 volunteers in the vaccine group, 24 developed HIV infection (3.2%), while among the 762 volunteers in the placebo arm of the trial, 21 developed HIV (2.75%). Notably, investigators in the study reported a higher risk of HIV infection was found among participants who had an existing immunity to the common cold virus (known as adenovirus type 5 or Ad5). The vaccine was created using a mixture of three components, each of which was made in the laboratory with a replication-defective version of Ad5. This was the organism selected to serve as a carrier, or delivery vector, for three synthetically produced HIV genes. Researchers suggested one explanation for the higher rate of HIV infection among individuals in the treatment group was that the vaccine lowered defenses against the human immunodeficiency virus. In other words, novel organisms created through splicing of genes from two naturally occurring pathogens may have increased the rate of disease. While other explanations of the results exist, the study suggests the possibility of the emergence of syndemics with an iatrogenic origin.

Examples of syndemics[edit]

Various syndemics (although not always labeled as such) have been described in the literature already, including: the SAVA syndemic (substance abuse, violence and AIDS): the hookworm, malaria and HIV/AIDS syndemic: the Chagas disease, rheumatic heart disease and congestive heart failure syndemic: the possible asthma and infectious disease syndemic: the malnutrition and depression syndemic: the TB, HIV and violence syndemic: the whooping cough, influenza, tuberculosis syndemic; the HIV and STD syndemic; the stress and obesity syndemic, and the mental health and HIV/AIDS syndemic. Additional syndemics are being identified around the world as public health officials, researchers, and service providers begin to focus on the connections among diseases and the social context factors that foster disease concentration and interactions. 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, Prince Charles, The Prince of Wales, noted the importance of paying attention to the built environment, physical inactivity and the obesity/diabetes syndemic.

Syndemics in history[edit]

While the rate at which new syndemics develop has accelerated through human history, as populations became larger and ever wider tracts of land were inhabited, as the speed of transportation increased with new technologies, and as human impact on the Earth's climatic and other environmental systems increased, syndemics are not a new phenomenon. Contact between Native Americans and Europeans led to syndemics among the Native American population due to diseases introduced during the Columbian Exchange. This resulted in many deaths due to the Native Americans' lack of built-up immunity to these diseases, which they had not encountered before.

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, victims of economic greed as well as a conscious plan to control Plains Indian populations. White hunting parties scoured the region, sometimes shooting hundreds or even thousands of bison a day. 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, as was typical of treaties with Native peoples, the government reneged on its promises. The food that was provided to the Sioux 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, and with inadequate diets, as well as being the victims of overt racism on the part of the registration agents appointed to oversee Indian reserves, the Sioux confronted exposure to infectious disease transmitted from contact with whites. While 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 who were removed to white boarding schools were diagnosed with a wide range of diseases, including tuberculosis, trachoma, measles, small pox, whooping cough, influenza, and pneumonia.

As these accounts suggest, it is likely that the Sioux were victims of a syndemic that combined a number of interacting infectious diseases (including the 1889–1890 flu pandemic), inadequate diet, and stressful and extremely disheartening life conditions, including, with events like the massacre at Wounded Knee in 1890 and the murder of their leader Sitting Bull, outright brutalization. As a result, while the official mortality rate on the reservation was between one and two percent, the death rate was probably closer to 10 percent, a devastatingly high figure.

The influenza syndemics[edit]

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. These factors unite a range of bio-social causal forces, including production, communication, and transportation technologies; the medical and public health infrastructures; the specific pathogens involved and the nature of their interactions with human hosts; and the pre-existing health status of patients. All of these, in turn, are shaped, to greater or somewhat lesser degree, by overarching political economic structures globally and locally. Epidemics, in short, including their emergence, course, and impact (and whether they become widespread pandemics that exact a sorrowful toll on life and well-being) are sculpted by the configuration of human social relationships including prevailing patterns of social inequality.

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 outbreak, which epidemiologists estimate was responsible for the deaths of between 40-100 million people worldwide, making it one of the most deadly events in human history. 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 (Bubonic plague) scourge that lasted from 1347 to 1351 (although a significantly higher percentage of the world’s population died of the plague than of Spanish flu). It is estimated that between 20-40 percent of the world’s population became ill during the 1918 pandemic.

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 places like India, the mortality rate reached 50 per 1,000 population. Arriving during the closing phase of the World War I, the pandemic had a significant impact on mobilized national armies. Half of U.S. soldiers who died in the "Great War," for example, were victims of influenza not of enemy bombs and bullets. It is estimated that almost ¾ of a million Americans died during the pandemic. As noted by one alarmed scientific observer at the time, "[if the pandemic continues] civilization could easily disappear from the face of the earth within a matter of a few more weeks". 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. In fact, 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. Moreover, 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 (because so many carriers of the disease perished during the influenza pandemic). Again, as seen with the previous two 20th century global influenza outbreaks, disease interaction appears to have been critical, underlining the importance of syndemics more generally in the production of major public health crises.

Syndemics and the environment[edit]

As a result of the floral changes produced by global warming, a significant escalation is occurring in global rates of allergies and asthma. Currently, allergic diseases constitute the sixth leading cause of chronic illness in the United States, impacting the lives of 17 percent of the population. Asthma, characterized by episodic inflammation and narrowing of small airway passages in the lungs, affects about 8 percent of the U.S. population, but the rate of affected individuals has been steadily climbing in recent years, especially in low income, ethnic minority neighborhoods in cities. Thus, in 1980 asthma was found to affect only about three percent of the U.S. population according to the U.S. Centers for Disease Control and Prevention. 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, 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 white people. As is so often the case with health, including health conditions directly affected by global warming, the poor and marginalized suffer the gravest consequences.

Increases in rates of asthma have occurred despite improvements in air quality produced by the passage and enforcement of clean air legislation, such as both the Clean Air Act of 1963 and the Clean Air Act of 1990 in the United States. In other words, 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. Research by the American Cancer Society found that a six percent increase in cardiopulmonary deaths occurs for every elevation of 10 μg/m3 in particulate matter concentration in the air. 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. According to Robert Pandya and co-workers who are studying the role of diesel fuel in asthma, "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 objective evidence of respiratory dysfunction."

Importantly, the damaging effects of diesel fuel pollution appears to go significantly beyond playing a synergistic role in the development of asthma. Recent research suggests that 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 significantly 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 who led the study of duel exposure, "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." The synergy begins when free radical molecules that are attached to diesel exhaust particles enter the body through the lungs and pass into the circulatory system. Another source of free radicals is the fatty acids that comprise LDL cholesterol, which produce free radicals during cell metabolism. Free radical molecules are highly unstable because they have an odd number of electrons in their outer ring. As a result, they react quickly with other compounds in order to "steal" an electron and gain stability. When the "victimized" molecule loses its electron, it, in turn, becomes a free radical and a chain reaction called oxidation is produced that is known to be damaging to living cells and tissues. Of interest to the Los Angeles research team was the consequences of both sources of free radical production coming into contact. 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. Atherosclerotic cardiovascular disease is the leading cause of death in developed countries.

Mathematical modelling of syndemics[edit]

A mathematical model is a simplified representation using mathematical language to describe natural, mechanical or social system dynamics. In the early 20th century, epidemiologists became increasingly interested in the use of mathematical modelling procedures to project possible patterns in the spread of infectious diseases, including potential outcomes of an epidemic. To achieve these goals, 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. Abu-Raddad, Patnaik, and Kublin (2006), for example, used modelling to quantify the syndemic effects of malaria and HIV in sub-Saharan Africa based on research in Kisumu, Kenya. These researchers point out that infection with HIV facilitates disease progression in individuals exposed to malaria. At the same time, immune reaction to malaria doubles the infectious level of HIV infected individual. In short, in typical syndemic fashion, each of these diseases amplifies the effects of the other. Using mathematical modelling, Abu-Raddad and co-workers 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. Other researchers (e.g., Herring and Sattenspiel 2007) also have begun to apply mathematical modelling to syndemics. 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.

In this regard, Jeremy Lauer and colleges (2003) have developed PopMod, a longitudinal population tool that models distinct and possibly interacting diseases. Unlike other life-table population models, PopMod is specifically 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 policy makers in the WHO’s 14 epidemiological sub-regions around the world with findings on a range of health intervention costs and effects.

Future research on syndemics[edit]

Medical anthropologist, epidemiologists, and clinical researchers are just beginning to understand the nature of syndemics. There is a critical need for new research in this area. Important arenas of inquiry include the following: First, there is a need for studies that examine the processes by which syndemics emerge, including the specific sets of health and social conditions that foster the occurrence of multiple epidemics in a population and how syndemics function to produce specific kinds of health outcomes in populations. 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. Specifically, 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 is contributing to the spread of diseases to new areas and to the potential for new disease interactions. Already it is clear that as a result of global warming infectious diseases such as West Nile Virus are spreading to new places. Similarly malaria is now found in new places because it is spread by particular mosquito species that are migrating to new locations as a result of changing climates. As a consequence, diseases that did not often interact in the past---through co-infection of the same individuals within a population---may begin interacting more regularly. Finally, there is a need for a better understanding of how the 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-bird medical and public health responses designed to lessen their impact. Systematic ethno-epidemiological surveillance with populations subject to multiple social stressors must be one component of such a monitoring system. Current efforts by researchers at the CDC to expand the discussion of syndemics in public health discourse is an important step in the development of a funded research agenda that addresses these research needs. Given the nature of syndemics, this research requires a bio-cultural/social approach that attends to both clinical and social processes.

See also[edit]

References[edit]

Further reading[edit]

A continually updated bibliography of the rapidly growing syndemics literature is provided below:

Books on Syndemics

  • Marshall, Mac 2013 Drinking Smoke: The Tobacco Syndemic in Oceania. Honolulu, HI: University of Hawai'i 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 Systems Approach to Public and Community Health. San Francisco, CA: Jossey-Bass.

Articles, Chapters, and Dissertations on Syndemics

  • Abu-Raddad, Laith, Patnaik, P., and Kublin, J 2006 Dual Infection with HIV and Malaria Fuels the Spread of Both Diseases in sub-Saharan Africa. Science 314:1603-1606.
  • Acevedo, Gabriel 2008 Causal Determinism, Elective Affinities, and Syndemic Networks: An Application of Epidemiological Theory to the Study of non-Medical Phenomenon. All Academic Research. Available online at: http://www.allacademic.com//meta/p_mla_apa_research_citation/1/8/4/6/3/pages184630/p184630-1.php.
  • Agnieszka, Kalwa, Szymanska,Bogna, Cholewinska, Grazyna, and Siwy-Hudowska Anna 2012 HIV/HCV Co-Infection—A Dual Neurocognitive Problem. World Journal of AIDS 2(1):33-41.
  • Akksilp, Somsak, Karnkawinpong, Opart, Wattanaamornkiat, Wanpen, Viriyakitja, Daranee, Monkongdee, Patama, Sitti, Walya, Rienthong, Dhanida, Siraprapasiri,Taweesap, Wells, Charles D., Tappero, Jordan W. and Varmaet, Jay K. 2007 Antiretroviral Therapy during Tuberculosis Treatment and Marked Reduction in Death Rate of HIV-infected Patients, Thailand. Emerging Infectious Diseases 13(7). Available online at: http://www.cdc.gov/EID/content/13/7/1001.htm.
  • Alisjahbana, B., van Crevel, R., Sahiratmadja, E., den Heijer, M., and Maya, A. 2006 Diabetes mellitus is strongly associated with tuberculosis in Indonesia. International Journal Tuberculosis and Lung Disease 10: 696–700.
  • Andreani, Guadalupe, Lodge, Robert, Richard, Dave and Tremblay, Michel 2012 Mechanisms of Interaction between Protozoanarasites and HIV. Current Opinion in HIV and AIDS 7:276-282.
  • Baer, Hans and Singer, Merrill 2008 Global Warming and the Political Ecology of Health: Emerging Crises and Systemic Solutions. Left Coast Press.
  • Baer, Hans, Singer, Merrill, and Susser, Ida 2004 Medical Anthropology and the World System. Begin & Garvey: Westport, CT.
  • Bayliss, Elizabeth, Steiner, John, Fernald, Douglas, Crane, Lori, and Main, Deborah 2003 Descriptions of Barriers to Self-Care by Persons with Comorbid Chronic Diseases. Annal of Family Medicine 1(1): 15-21.
  • Bastos, Francisco Inacio, Barcellos, Christovam, Lowndes, Catherine, and Friedman, Samuel 1999 Co-infection with malaria and HIV in injecting drug users in Brazil: a new challenge to public health? Addiction 94 (8): 1165–1174.
  • Bennett, Elaine 2009 Understanding childhood malnutrition in a Maya village in Guatemala: A syndemic perspective. Doctoral Dissertation. Department of Anthropology, University of Connecticut.
  • Bini, Edmund and Perumalswami, Ponni 2010 Hepatitis B Virus Infection Among American Patients with Chronic Hepatitis C Virus Infection: Prevalence, Racial/Ethnic Differences, and Viral Interactions. Hepatology51:759-766.
  • Brennan, Julia, Kuhns, Lisa, Johnson, Amy, Belzer, Marvin, Wilson, Erin and Garofalo, Robert 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.
  • Bruce, Douglas, Harper, Gary and the Adolescent Medicine Trials Network for HIV/AIDS Interventions 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 and Behavior 38(4):367-378.
  • Brunarski, David 2011 The Increasing Threat of Syndemics and the Role of Chiropractic Care. Dynamic Chiropractic 4(2):1.
  • Brunner, E., Chandola, T. and Marmot, M. 2007 Prospective Effect of Job Strain on General and Central Obesity in the Whitehall II Study. American Journal of Epidemiology 165:828-837.
  • Bulled, Nicola and Singer, Merrill 2011 Syringe-mediated Syndemics. AIDS and Behavior 15(7):1539-1545.
  • Burke, J., Lim, S. H., Marshal, M.. Silvestre A., Albert, S., Ostrow, D. and R. Stall, R. 2010 Longitudinal patterns of frequent drug use among HIV-positive and negative aging men who have sex with men (MSM) in the Multicenter AIDS Cohort Study (MACS). Presented at the XVIII International AIDS Conference, July 18–23. Vienna, Austria.
  • Burke, Stacie 2011 Tuberculosis: Past and Present. Reviews in Anthropology 40(1):27-52.
  • Buttran, Mance, Surratt, Hilary and Kurtz, Steven 2013 Resilience and syndemic risk factors among African-American female sex workers. Psychology, Health & Medicine Online ahead of publication DOI:10.1080/13548506.2013.824595.
  • 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): 1008-1013.
  • 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 http://www.cdc.gov/EID/content/15/2/258.htm
  • Candib, Lucy 2007 Obesity and Diabetes in Vulnerable Populations: Reflection on Proximal and Distal Causes. Annals of Family Medicine 5:547-556.
  • Chatterjee, R. 2007 Portrait of a Killer. ScienceNow 117(2). Available online at: http://news.sciencemag.org/sciencenow/2007/01/17-02.html.
  • Chaulk, C. Patrick and Kazandjian, Vahé 2004 Moving Beyond Randomized Controlled Trials. American Journal of Public Health 94(9):1476.
  • Cohen, Craig, Duerr, Ann, Pruithithada, Niwat, Rugpao, Sungwal, Garcia, Patricia, Nelson, Kenrad and Hillier, Sharon 1995 Bacterial Vaginosis and HIV Seroprevalence among Female Commercial Sex Workers in Chiang Mai, Thailand. AIDS 9(9):1093-1098.
  • 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, K. and Kaleeba, J. 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.
  • Correa-Oliveira, R., Golgher, D., Oliveira, G., Carvalho, O., Massara, C., Caldas, I., Colley, D. and Gazzinelli, G. 2002 Infection with Schistosoma mansoni correlates with altered immune responses to Ascaris lumbricoides and hookworm. Acta Tropica 83: 123–132.
  • Cui, Yang and 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 Behavior 15(Suppl 1):S35-S50.
  • Daftary, A. 2012 HIV and tuberculosis: The construction and management of double stigma.Social Science & Medicine 74(10):1512-1519.
  • Daftary, A. and Padayatchi, N. 2012 Social constraints to TB/HIV healthcare: Accounts from coinfected patients in South Africa. AIDS Care [Epub ahead of print].
  • De Santis, Joseph, Layerla, Dennys, Barroso, Susana, Gattamorta, Karina, Sanchez, Michael, and Prado, Guillermo 2012 Predictors of Eating Attitudes and Behaviors Among Gay Hispanic Men. Archives of Nursing 26(2):111-126.
  • Diedrich, C. and Flynn, J. 2011 HIV-1/Mycobacterium tuberculosis Coinfection Immunology: How Does HIV-1 Exacerbate Tuberculosis? Infection and Immunity 79(4):1407-1417.
  • Dyer, T., Shoptaw, S., Guadamuz, T., Plankey, M., Kao, U., Ostrow, D., Chmiel, J., Herrick A., and 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.
  • Easton, Delia 2004 The Urban Poor: Health Issues. Encyclopedia of Medical Anthropology, Volume 1, pp. 207–213. New York: Kluwer Academic/Plenum Publishers.
  • Edberg, Mark, Cleary, Sean, and Vyas, Amita 2010 A Trajectory Model for Understanding and Assessing Health Disparities in Immigrant/Refugee Communities. Immigration and Minority Health 13(3):576-584.
  • Edmundo, Kátia, de Mello e Souza, Cecília, de Carvalho, Maria Luiza and Paiva, Vera 2007 HIV vulnerability in a shantytown: the impact of a territorial intervention, Rio de Janeiro, Brazil. Revista de Saúde Pública 41(Supplement 2):127-134.
  • Egan, James, Frye, Victoria, Kurtz, Steven, Latkin, Carl, Chen, Minxing, Tobin, Karin, Yang, Curi, and Kobtin, 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(Sup 1): 35-50.
  • Eisenberg, M. and Blank, M. 2014 The Syndemic of the Triply Diagnosed: HIV Positives with Mental Illness and Substance Abuse or Dependence. Clinical Research in HIV/AIDS 1(1): 1006.
  • Engel, Jeffery 2007 Pandemic Influenza: The Critical Issues and North Carolina’s Preparedness Plan. North Carolina Medical Journal 68(1):32-37.
  • Everett, Margaret 2009 Diabetes Among Oaxaca’s Transnational Indigenous Population: An Emerging Syndemic. Presented at the 2009 Congress of the Latin American Studies Association, Rio de Janeiro, Brazil June 11–14, 2009. Available online at: http://lasa.international.pitt.edu/members/congress-papers/lasa2009/files/EverettMargaret.pdf.
  • Everett, Margaret and Wieland, Josef 2013 Diabetes Among Oaxaca’s Transnational Population: An Emerging Syndemic. Annals of Anthropological Practice 36(2):293-309.
  • Ezeamama, A., McGarvey, S., Acosta, L., Zierler, S., Manalo, D., Wu, H-W., Kurtis, J., Mor, V., Remigio, O. and Friedman, J. 2008 The Synergistic Effect of Concomitant Schistosomiasis, Hookworm, and Trichuris Infections on Children’s Anemia Burden. PLoS Neglect Tropical Diseases 2(6): e245.
  • Fama, Rosemary, Rosenbloom, Margaret, Nichols, B. Nolan, Pfefferbaum, 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): 1815-1825.
  • Fasula, Amy, Miller, Kim and 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: 261–263.
  • 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.
  • Ferlatte, Oliver, Hottes, Travis, Trussler, Terry and 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 epub ahead of publication: DOI:10.1007/s10461-013-0639-.
  • Fleming, F., Brooker, S., Geiger, S., Caldas, I., Correa-Oliveira, R., Hotez, P. and Bethony, J.. 2006 Synergistic associations between hookworm and other helminth species in a rural community in Brazil. Tropical Medicine and International Health 11: 56–64.
  • Florey, Lia, King, Charles, Van Dyke, Melissa, Muchiri, Eric, Mungai, Peter, Zimmerman, Peter, and 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.
  • Fiorella, Kathryn 2013 Considering the Complexity in HIV/AIDS and the Environment. American Journal of Public Health 103(9):e1-e1 (in press).
  • Freudenberg, N., Fahs, M., Galea, S., & Greenberg, A. 2006 The impact of New York City’s 1975 fiscal crisis on the tuberculosis, HIV, and homicide syndemic. American Journal of Public Health, 96(3): 424–434.
  • Friedman, M. Reuel, Kutz, Steven, Buttram, Mance, Wei, Chongyi, Silvestre, Anthony, and Stall, Ron 2013 HIV Risk Among Substance-Using Men Who Have Sex with Men and Women (MSMW): Findings from South Florida. AIDS and Behavior (in press).
  • Garcia, J., Hromi-Fiedler, A., Mazur, R., Marquis, G., Sellen, D., Lartey, A, and 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.
  • Geldmacher, C., Zumla, A. and 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/AIDS 7(3):268-274.
  • Gerberding, J. 2005 Protecting Health — The New Research Imperative. Journal of the American Medical Association 294(11): 1403-1406.
  • Gerns, Helen, Sangare, Laura and 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.
  • Getahun, Haileyesus, Raviglione, Mario, Varma, Jay, Cain, Kevin, Samandari, Taraz, Popovic, Tanja, and Frieden, Thomas 2012 CDC Grand Rounds: the TB/HIV Syndemic. Morbidity and Mortality Weekly Report (MMWR) 61(26):484-489.
  • Gielen, A., Ghandour, R., Burke, J., Mahoney, P., McDonnell, K., and 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):179-198.
  • González-Guarda, Rosa 2009 The Syndemic Orientation: Implications for Eliminating Hispanic Health Disparities. Hispanic Health Care International 7(3):114-115.
  • 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., and Thomas, T. 2011 A syndemic model of substance abuse, intimate partner violence, HIV infection, and mental health among Hispanics. Public Health Nursing 28(4):366-378.
  • 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):182-189.
  • González-Guarda, Rosa,De Santis, Joseph, and 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): 103–109.
  • González-Guarda, McCabe, Brian, Vermeesch, Amber, Cianelli, Rosina, Florom-Smith, Aubrey and Nilda, Peragallo 2013 Cultural Phenomena and the Syndemic Factor: Substance Abuse, Violence,HIV, and Depression Among Hispanic Women. Annals of Anthropological Practice 36(2):212-231.
  • González-Guarda, Rosa 2013 Pushing the Syndemic Research Agenda Forward: a Comment on Pitpitan et al. Annals of Behavioral Medicine 45(2):135-136.
  • Grund, Jean-Paul, Latypov, Alisher, and 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):265-274.
  • Guadamuz, Thomas, Friedman, Mark, Marshal, Michael, Herrick, Amy, Lim, Sin How, Wei, Chongyi, and Stall, Ron 2013 Health, Sexual Heath, 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.
  • Halkitis, P., Moeller, R., Siconolfi, D., Storholm, E., Solomon, T. and Bub, K. 2012 Measurement Model Exploring a Syndemic in Emerging Adult Gay and Bisexual Men. AIDS and Behavior 17(2):662-673.
  • Halkitis, Perry, Kupprat, Sandra, Hampton, Melvin, Perez-Figueroa, Rafael, Kindon, Molly, Eddy, Jessica and 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):363-384.
  • Hardin, Amy, Crandall, Philip and 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.
  • Hein, Casey and Small, Doreen 2007 Combating Diabetes, Obesity, Periodontal Disease and Interrelated Inflammatory Conditions with a Syndemic Approach. Available online at:http://www.healthdecisions.org/Dental/News/default.aspx?doc_id=109688.
  • Herrick, Amy, Lim, Sin, Wei, Chongyi, Smith, Helen, Guadamuz, Thomas, Friedman, Mark and Stall, Ron 2011 Resilience as an Untapped Resource in Behavioral Intervention Design for Gay Men. AIDS and Behavior 15(Suppl 1):S25-S29.
  • Herrick, Amy, Lim, Sin, Plankey, Michael, Chmiel, Joan, Guadamuz, Thomas, Kao, Uyen, Shoptaw, Steven, Carrico, Adam, Ostrow, David and 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.
  • 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.
  • Herring, D. Ann and Sattenspiel, Lisa 2007 Social Contexts, Syndemics, and Infectious Disease in Northern Aboriginal Populations. American Journal of Human Biology 19:190-202.
  • 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, and Sellen, Daniel 2009 Addressing the HIV/AIDS-food insecurity syndemic in sub-Saharan Africa. African Journal of AIDS Research 8(4):401-412.
  • Himmelgreen, David and Romero-Daza, Nancy 2010 The Global Food Crisis, HIV/AIDS, and Home Gardens. Environment: Science and Policy for Sustainable Development June–July. Online at: http://www.environmentmagazine.org/Bytes%20of%20Note/Bytes-index.html.
  • Himmelgreen, David, Romero-Daza, Nancy, Amador, Edgar, and 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):344-362.
  • Iacopin, Anthony 2009 New 'Syndemic' Paradigm for Interprofessional Management of Chronic Inflammatory Disease. Journal of the Canadian Dental Association 75(9): 632-633.
  • Illangasekare, Samanha Lakmali 2011 The Role of the Intimate Partner Violence, HIV, and Substance Abuse Syndemic in Women's Mental Health. Doctoral Dissertation, the Johns Hopkins University.
  • Illangasekare, S., Burke, J., Chander, G. and 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. [Epub ahead of print]
  • Ivan, Emil, Nigel Crowther, Eugene Mutimura, Lawrence Obado Osuwat, Saskia Janssen and Martin P. Grobusch 2013 Helminthic Infections Rates and Malaria in HIV-Infected Pregnant Women on Anti-Retroviral Therapy in Rwanda. PLoS Neglected Tropical Diseases 7(8): e2380. doi:10.1371/journal.pntd.0002380.
  • Jie, Wu, Ciyong, Lu, Xueqing, Deng, Hui,Wang, Lingyao, Hong 2012 A Syndemic of Psychosocial Problems Places the MSM (Men Who Have Sex with Men) Population at Greater Risk of HIV Infection. PLoS ONE 7(3):e32312.
  • Jittimanee, Sirinapha, Nateniyom, Sriprapa, Kittikraisak,Wanitchaya, Burapat, Channawong, Akksilp, Somsak, Chumpathat, Nopphanath, Sirinak, Chawin, Sattayawuthipong, Wanchai and Varma, Jay 2009 Social Stigma and Knowledge of Tuberculosis and HIV among Patients with Both Diseases in Thailand. PLoS ONE 4(7): e6360. doi:10.1371/journal.pone.0006360.
  • Johnson, Roger B. 2007 Periodontitis as a Component of Hyperinflammation: Treating Periodontitis in Obese Diabetic Patients. Compendium 28(9):500-505.
  • Kant, L. 2003 Diabetes Mellitus-Tuberculosis: The Brewing Double Trouble. Indian Journal of Tuberculosis 50(4): 83-84.
  • Kelly, Patricia, Cheng, An-Lin, Spencer-Carver, Elaine and Ramaswamy, Megha 2012 A Syndemic Model of Women Incarcerated in Community Jails. Public Health Nursing (in press) DOI: 10.1111/phn.12056.
  • Klein, High 2011 Using a Syndemics Theory Approach to Study HIV Risk Taking in a Population of Men Who Use the Internet to Find Partners for Unprotected Sex. American Journal of Men's Health 5(6):466-476.
  • Klein, Hugh 2013 Condom Use Self-Efficacy and HIV Risk Practices Among Men Who Use the Internet to Find Male Partners for Unprotected Sex. American Journal of Men's Health (in press).
  • Kline, Nolan 2013 “There’s Nowhere I Can Go to Get Help, and I have Tooth Pain Right Now”: The Oral Health Syndemic Among Migrant Farmworkers in Florida. Annals of Anthropological Practice 36(2):385-399.
  • Kurtz, Steven 2008 Unexpected Additional Evidence For Syndemic Theory. Journal of Psychoactive Drugs 40 (4):513-521.
  • Kurtz, Steven, Buttram, Mance, Surratt, Hilary and Stall, Ronald 2012 Resilience, Syndemic Factors, and Serosorting Behaviors among HIV-Positive and HIV-Negative Substance-Using MSM. AIDS Education and Prevention 24(3):193-205.
  • Kwan, C. and Ernst, J. 2011 HIV and Tuberculosis: A Deadly Human Syndemic. Clinical Microbiology Reviews 24(2):351-376.
  • Laserson, K. and Wells, C. 2007 Reaching the Targets for Tuberculosis Control: The impact of HIV. Bulletin of the World Health Organization 85(5). Available on at: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862007000500016&lng=&nrm=iso.
  • Lauer, Jeremy, Röhrich, Klaus, Wirth, Harald, Charette, Claude, Gribble, Steve, and Murray, Christopher 2003 PopMod: a longitudinal population model with two interacting disease states. Cost Effectiveness and Resource Allocation 2003; 1: 6. Online publication at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=156025.
  • Leuer, Marie, Abonyi, Sylvia and Smadu, Marlene 2013 A Syndemic Perspective of Negative Childhood Outcomes: Parenting in a “Perfect Storm” of Disadvantaged Conditions. Journal of Poverty 17(2):198-216.
  • Lim, S.H. Herrick, A., Guadamuz, T., Kao, U., Plankey, M., Ostrow, D., Shoptaw, S. and Stall, R. 2010 Childhood sexual abuse, gay-related victimization, HIV infection and syndemic productions among men who have sex with men (MSM): findings from the Multicenter AIDS Cohort Study (MACS). Presented at the XVIII International AIDS Conference, July 18–23. Vienna, Austria.
  • Limmahakhun, S., Chaiwarith, R., Nuntachit, N., Sirisanthana, T. and Supparatpinyo, K. 2012 Treatment outcomes of patients co-infected with tuberculosis and HIV at Chiang Mai University Hospital, Thailand International Journal of STD and AIDS 23(6):414-418.
  • Littleton, Juditith and Julia Park 2009 Tuberculosis and syndemics: Implications for Pacific health in New Zealand. Social Science & Medicine (11):1674-1680.
  • Littleton, Judith, Julie Park, Ann Herring and Tracy Farmer 2008 Multiplying and Dividing Tuberculosis in Canada and Aotearoa New Zealand, Research in Anthropology and Linguistics e3. University of Auckland.
  • Littleton, Judith, Park, Julie and Nelesone, Tekaai 2013 Helminths and TB in Polynesia: The Implications for Health Practice. Annals of Anthropological Practice 36(2):273-292.
  • Lyons, Thomas, Johnson, Amy and Garofalo, Robert 2013 "What Could Have Been Different": A Qualitative Study of Syndemic Theory and HIV Prevention Among Young Men Who Have Sex With Men. Journal of HIV/AIDS & Social Services (in press).
  • Marshall, Mac 2005 Carolina in the Carolines: A Survey of Patterns and Meanings of Smoking on a Micronesian Island. Medical Anthropology Quarterly 19(4):354-382.
  • Martin, Yolanda 2013 The Syndemics of Removal: Trauma and Substance Abuse. In Outside Justice: Immigration and the Criminalizing Impact of Changing Policy and Practice edited by David Brotherton, Daniel Stageman and Shirley Leyro. New York: Springer, 91-107.
  • Mavridis, Agapi 2008 Tuberculosis and Syndemics: Implications for Winnipeg, Manitoba. In Multiplying and Dividing Tuberculosis in Canada and Aotearoa New Zealand, Judith Littleton, Julie Park, Ann Herring and Tracy Farmer, Eds. Research in Anthropology and Linguistics e3: 43-53.
  • Mazigo, Humphrey, Nuwaha, Fred, Wilson, Shona, Kinung'hi, Safari, Morona, Domenica, Waihenya, Rebecca, Heukelbach, Jorg and Dunne, David 2013 Epidemiology and interactions of Human Immunodeficiency Virus – 1 and Schistosoma mansoni in sub-Saharan Africa. Infectous Diseases of Poverty 2:2 doi:10.1186/2049-9957-2-2.
  • McCullers, Jonathon 2006 Insights into the Interaction between Influenza Virus and Pneumococcus. Microbiology Reviews 19(3):571-582.
  • MacQueen, Kate 2002 Anthropology and Public Health. Encyclopedia of Public Health. New York: Macmillan Reference.
  • McKenney, David, Brown, Kathryn, and Allison, David 1995 Influence of Pseudomonas aeruginosa Exoproducts on Virulence Factor Production in Burkholderia cepacia: Evidence of Interspecies Communication. Journal of Bacteriology 177(23): 6989-6991.
  • McKenzie, Kellye, Mbajah, Joy, Seegers, Angela, and Davis, Celeste 2008 The Landscape of HIV/AIDS among African American Women in the United States. NASTAD National Alliance of State and Territorial AIDS Directors. Issue Brief No. 1:1-12.
  • Mercado, Susan, Kirsten Havemann, Keiko Nakamura, Andrew Kiyu, Mojgan Sami, Roby Alampay, Ira Pedrasa, Divine Salvador, Jeerawat Na Thalang, and Tran Le Thuey 2007 Responding to the Health Vulnerabilities of the Urban Poor in the ‘New Urban Settings’ of Asia. Presented at Improving Urban Population Health Systems, sponsored by the Center for Sustainable Urban Development, July.
  • Millstein, Bobby 2001 Introduction to the Syndemics Prevention Network. Atlanta: Centers for Disease Control and Prevention.
  • Millstein, Bobby 2004 Syndemics. In: Encyclopedia of Evaluation. Sandra Mathison, Ed. Pp. 404–405. Thousand Oaks, CA: Sage Publications.
  • Moellera, Robert, Halkitisa, Perry, and Surrencea, Katie 2011 The Interplay of Syndemic Production and Serosorting in Drug-Using Gay and Bisexual Men. Journal of Gay & Lesbian Social Services 23(1):89-106.
  • Meyer, Jaimie, Springer, Sandra, Altice and Altice, Frederick 2011 Substance Abuse, Violence, and HIV in Women: A Literature Review of the Syndemic. Journal of Women's Health 20(7):996-1006.
  • Mizuno, Y., Borkowf, C., Millett, G., Bingham, T., Ayala, G., and Stueve, A. 2011 Homophobia and Racism Experienced by Latino Men Who Have Sex with Men in the United States: Correlates of Exposure and Associations with HIV Risk Behaviors. AIDS and Behavior 16(3):724-735.
  • Morano, Jamie, Gibson, Britton, and Altice, Fredrick 2013 The Burgeoning HIV/HCV Syndemic in the Urban Northeast: HCV, HIV, and HIV/HCV Coinfection in an Urban Setting. PLoS One 8(5): e64321. doi:10.1371/journal.pone.0064321.
  • Morens, D., Taubenberger, J., and Fauci, A. 2008 Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness. The Journal of Infectious Diseases 198(7):962-970.
  • Mustanski, Brian, Garofalo, Robert, Herrick, Amy and Donenberg, Geri 2007 Psychosocial health problems increase risk for HIV among urban young men who have sex with men: Preliminary evidence of a syndemic in need of attention. Annals of Behavioral Medicine 34(1):37-45.
  • Mustanski, Brian, Andrews, Rebecca, Herrick, Amy, Stall, Ron and Schnarrs, Phillip 2014 A Syndemic of Psychosocial Health Disparities and Associations With Risk for Attempting Suicide Among Young Sexual Minority Men. American Journal of Public Health 104(2):287-294.
  • Myslobodsky, M. and Eldan, A. 2010 Winning a Won Game: Caffeine Panacea for Obesity Syndemic. Current Neuropharmacology 8(2):149-160.
  • Nichter, Mark 2003 Harm Reduction, Harm Reduction, Ecosocial Epidemiology, Ecosocial Epidemiology, and Syndemics. Online at: http://www.csiss.org/events/meetings/risk-perception/docs/nichter_presentation.pdf
  • Noymer, Andrew and Michel Garenne 2000 The 1918 Influenza epidemic's effects on sex differentials in mortality in the United States.Population and Development Review 26(3):565–581 Online at: http://www.demog.berkeley.edu/~andrew/1918/PDR_1918_flu.pdf
  • Operario, Don and Tooru Nemoto 2010 HIV in Transgender Communities: Syndemic Dynamics and a Need for Multicomponent Intervention. JAIDS: Journal of Acquired Immune Deficiency Syndromes 55:S91-S93.
  • Ostrach, Bayla and Singer, Merrill 2012 At Special Risk: Biopolitical Vulnerability and HIV Syndemics Among Women. Health Sociology Review doi:10.5172/hesr.2012.1532-1569.
  • Ostrach, Bayla and Singer Merrill 2013 Syndemics of War: Malnutrition-Infectious Disease Interactions and the Unintended Health Consequences of Intentional War Policies. Annals of Anthropological Practice 36(2):256-272.
  • Padilla, Mark, Guilamo-Ramos, Vincent, and Godbole, Ramona 2011 A Syndemic Analysis of Alcohol Use and Sexual Risk Behavior Among Tourism Employees in Sosúa, Dominican Republic. Qualitative Health Review 22(1):89-102.
  • Pablos-Mendez, A., Blustein, J. and Knirsch, C. 1997 The role of diabetes mellitus in the higher prevalence of tuberculosis among Hispanics. American Journal of Public Health 87: 574–579.
  • Parsons, Jeffrey, Grov, C., and Golub, S. 2011 'Sexual Compulsivity, Co-Occurring Psychosocial Health Problems, and HIV Risk Among Gay and Bisexual Men: Further Evidence of a Syndemic. American Journal of Public Health 102(1):156-162.
  • Patel, Pragnesh and Voigt, Michael 2002 Prevalence and interaction of hepatitis B and latent tuberculosis in Vietnamese immigrants to the United States. The American Journal of Gastroenterology 97:1198-1203.
  • Perez, A., Brown, H. and Restrepo, B. 2006 Association between tuberculosis and diabetes in the Mexican border and non-border regions of Texas. American Journal of Tropical Medicine and Hygiene 74: 604–611.
  • Pitpitan, E., Kalichman, S., Eaton, L., Cain, D., Sikkema, K., Watt, M., Skinner, D., and Pieterse, D. 2012 Co-occurring Psychosocial Problems and HIV Risk Among Women Attending Drinking Venues in a South African Township: A Syndemic Approach. Annals of Behavioral Medicine 45(2):153-162.
  • Ponce-De-Leon, A., Garcia-Garcia, L., Garcia-Sancho, M., Gomez-Perez, F., and Valdespino-Gomez, J. 2004 Tuberculosis and diabetes in southern Mexico. Diabetes Care 27: 1584–1590.
  • Raso G., Luginbuhl A., Adjoua C., Tian-Bi, N., Silué, K., Matthys,B., Vounatsou, P., Wang,Y., Dumas, M-E., Holmes, E., Singer, B., Tanner, M., Goran, E. and Utzinger, J. 2004 Multiple parasite infections and their relationship to self-reported morbidity in a community of rural Côte d'Ivoire. International Journal of Epidemiology 33:1092-1102.
  • Reitmanova, Sylvia and Gustafson, Diana 2012 Coloring the white plague: a syndemic approach to immigrant tuberculosis in Canada. Ethnicity and Health 17(4):403-418.
  • Ribera, Joan Muela, and Hausmann-Muela, Susanna 2011 The Straw that Breaks the Camel's Back Redirecting Health-Seeking Behavior Studies on Malaria Vulnerability. Medical Anthropology Quarterly 25(1):103-121.
  • Reddi, Anand, Powers, Matthew, and Thyssen Andreas 2012 HIV/AIDS and food insecurity: deadly syndemic or an opportunity for healthcare synergism in resource-limited settings of sub-Saharan Africa? AIDS2(1):115-7.
  • Rock, Melanie, Bonnie Buntain, Jennifer Hatfield, & Benedikt Hallgrimsson 2009 Animal-human connections, 'one health,' and the syndemic approach to prevention. Social Science & Medicine 68(6):991-995.
  • Rock, Melanie 2013 Connecting Lives: Reflections on a Syndemic Approach to Prevention Involving Research on How People Relate to Pets. Annals of Anthropological Practice 36(2):310-325.
  • Romero-Daza, Nancy, Baldwin, Julie, Lescano, Celia, Williamson, Heather, Tilley, David, Chan, Isabella, Tewell, Mackenzie and Palacios, Wilson 2013 Syndemic Theory as a Model for Training and Mentorship to Address HIV/AIDS Among Latinos in the United States. Annals of Anthropological Practice 36(2):232-255.
  • Rosenberg, Rhonda and Malow, Robert 2006 Hardness of Risk: Poverty, Women and New Targets for HIV/AIDS Prevention. Psychology & AIDS Exchange34:3-4, 9, & 12.
  • Rhodes, Jeselyn 2010 Early Syphilis and HIV Syndemic in Nashville/Davidson Co., Tennessee: Implications for Improving Syphilis Screening for People Living with and at Risk for HIV. Presented at the National STD Prevention Conference. Atlanta, GA.
  • Ruiz, Juan and Marc Egli 2010 Metabolic Syndrome, Diabetes Mellitus and Vulnerability: A Syndemic Approach to Chronic Diseases. Revue Medicale de la Suisse Romande 6(271):2205-2208.
  • Russell, Beth, Eaton, Lisa, and Petersen,-Williams, Petal 2013 Intersecting Epidemics Among Pregnant Women: Alcohol Use, Interpersonal Violence, and HIV Infection in South Africa. Current HIV/AIDS Reports 10(1):103-110.
  • Safren, Steven, Reisner, Sari, Herrick, Amy, Mimiaga, Matthew, and Stall, Ronald 2010 Mental Health and HIV Risk in Men Who Have Sex With Men. Journal of Acquired Immune Deficiency Syndromes 55:S74-S77.
  • Safren, Steven, Blashill, Aaron and O’Cleirigh, Conall 2011 Promoting the Sexual Health of MSM in the Context of Comorbid Mental Health Problems. AIDS and Behavior Supplement 1:S30-34.
  • Sathekge, Mike, Maes, Alex, Van de Wiele, Christophe 2013 FDG-PET Imaging in HIV Infection and Tuberculosis Seminars in Nuclear Medicine 43(5):349-366.
  • Sattenspiel, Lisa and Herring, Ann 2010 Emerging Themes in Anthropology and Epidemiology: Geographic Spread, Evolving Pathogens and Syndemics. In Clark Spencer Larsent, ED. A Companion to Biological Anthropology. Malden, MA: Wiley.
  • Sattenspiel, Lisa and Mamelund, Svenn-Erik 2013 Cocirculating Epidemics, Chronic Health Problems, and Social Conditions

in Early 20th Century Labrador and Alaska. Annals of Anthropological Practice 36(2):400-419.

  • Scheiblauer, H., Reinacher, M, Tashiro, M. and Rott, R. 1992 Interactions Between Bacteria and Influenza A Virus in the Development of Influenza Pneumonia. Journal of Infectious Diseases 166: 783-791.
  • Scrimshaw, Neville, Taylor Carl, and Gordon, John 1968 Interactions of Nutrition and Infection. Geneva: World Health Organization
  • Secor, W., Karanja, D., and Colley, D. 2004 Interactions between Schistosomiasis and Human Immunodeficiency Virus in Western Kenya. Memorias do Instituto Oswaldo Cruz 99 (5 Suppl. 1):93–95.
  • 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):614-620.
  • Sethi, Sanjeev 2002 Bacterial Pneumonia. Managing a Deadly Complication of Influenza in Older Adults with Comorbid Disease. Geriatrics 57(3):56-61.
  • Shaikh, M., Singla, R., Khan, N., Sharif, N., and Saigh, M. 2003 Does Diabetes Alter the Radiological Presentation of Pulmonary Tuberculosis. Saudi Medical Journal 24(3):278-281
  • Sheretz, R., Reagan, D., Hampton, K., Robertson, K., Streed, S., Hoen, H., Thomas, R., and Gwaltney, J. Jr. 1996 A Cloud Adult: The Staphylococcus aureus-virus Interaction Revisited. Annals of Internal Medicine 124(6):539-547.
  • Shields, Sara and Lucy M. Candib, Eds. 2010 Women-Centered Care in Pregnancy and Childbirth. Oxon, United Kingdom: Radcliffe Publishing Ltd.
  • Sibley, Candace Danielle 2011 A Multi-Methodological Study of a Possible Syndemic among Female Adult Film Actresses. MSPH Thesis University of South Florida.
  • Sikkema, Kathleen, Watt, Melissa, Meade, Christina, Ranby, Krista, Kalichman, Seth, Skinner, Donald, and Pieterse, Desiree 2011 Mental Health and HIV Risk Behavior Among Patrons of Alcohol Serving Venues in Cape Town, South Africa. Journal of Acquired Immune Deficiency Syndromes 57(3): 230-237.
  • Singer, Merrill 1994 AIDS and the Health Crisis of the US Urban Poor: The Perspective of Critical Medical Anthropology. Social Science and Medicine 39(7):931-948.
  • Singer, Merrill 1996 A Dose of Drugs, a Touch of Violence, A Case of AIDS: Conceptualizing the SAVA Syndemic. Free Inquiry in Creative Sociology 24(2):99-110.
  • Singer, Merrill 2004 Critical Medical Anthropology. In Encyclopedia of Medical Anthropology: Health and Illness in the World’s Cultures. Vol. 1:23-30. Carol Ember and Melvin Ember, (eds). New York: Kluwer.
  • Singer, Merrill 2006 Syndemics. Encyclopedia of Epidemiology. Sarah Boslaugh (ed). Thousand Oaks, CA:Sage Publications, Inc.
  • Singer, Merrill 2006 A Dose of Drugs, A Touch of Violence, A Case of AIDS, Part 2: Further Conceptualizing the SAVA Syndemic. Free Inquiry in Creative 34(1): 39-56.
  • Singer, Merrill 2008 The Perfect Epidemiological Storm: Food Insecurity, HIV/AIDS and Poverty in Southern Africa. Anthropology Newsletter(American Anthropological Association) 49(7): 12 & 15 October.
  • Singer, Merrill 2008 Drug-related Syndemics and the Risk Environment: Assessing Street risk among Hispanics in Hartford. Presented at the 8th Annual National Hispanic Science Network on Drug Abuse. Bethesda, Maryland.
  • Singer, Merrill 2009 Desperate Measures: A Syndemic Approach to the Anthropology of Health in a Violent City. In Global Health in the Time of Violence, Barbara Rylko-Bauer, Linda Whiteford, and Paul Farmer, Editors. Sante Fe, NM: SAR Press.
  • Singer. Merrill 2009 Doorways in Nature: Syndemics, Zoonotics, and Public Health: A Commentary on Rock, Buntain, Hatfield & Hallgrímsson. Social Science & Medicine 68(6):996-999.
  • Singer, Merrill 2009 Pathogens Gone Wild?: Medical Anthropology and the "Swine Flu" Pandemic. Medical Anthropology 28(3): 199–206.
  • Singer, Merrill 2010 Pathogen-Pathogen Interaction: A Syndemic Model of Complex Biosocial Processes in Disease. Virulence 1(1):10-18.
  • Singer, Merrill 2010 Ecosyndemics: Global Warming and the Coming Plagues of the 21st Century. In Plagues: Models and Metaphors in the Human ‘Struggle’ with Disease, D. Ann Herring and Alan C. Swedlund, Editors, pp. 21–38. London: Berg.
  • Singer, Merrill 2011 Double Jeopardy: Vulnerable Children and the Possible Global Lead Poisoning/Infectious Disease Syndemic. In Routledge Handbook in Global Health, Richard Parker and Marni Sommer, Editors, pp. 154–161. New York: Routledge.
  • Singer, Merrill 2011 The Infectious Disease Syndemics of Crack Cocaine. Journal of Equity in Health (in press).
  • Singer, Merrill 2011 Toward a Critical Biosocial Model of Ecohealth in Southern Africa: The HIV/AIDS and Nutrition Insecurity Syndemic. Annals of Anthropology Practice 35(1):8-27.
  • Singer, Merrill and Baer, Hans 2007 Introducing Medical Anthropology: A Discipline in Action. AltaMira/ Rowman Littlefield Publishers, Inc.
  • Singer, Merrill and Clair, Scott 2003 Syndemics and Public Health: Reconceptualizing Disease in Bio-Social Context. Medical Anthropology Quarterly 17(4): 423-441.
  • Singer, Merrill, Erickson, Pamela, Badiane, Louise, Diaz, Rosemary,Ortiz, Dueidy, Traci Abraham, and Nicolaysen, Anna Marie 2006 Syndemics, Sex and the City: Understanding Sexually Transmitted Disease in Social and Cultural Context. Social Science and Medicine 63(8):2010-2021.
  • 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. 219–249. Malden, MA: Wiley-Blackwell.
  • Singer, Merrill and 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): 325-239.
  • Singer, Merrill, Bulled, Nicola and Ostrach, Bayla 2013 Syndemics and Human Health: Implications for Prevention and Intervention. Annals of Anthropological Practice 36(2):205-211.
  • Singer, Merrill and Weeks, Margaret 2005 The Hartford Model of AIDS Practice/Research. In Community Interventions and AIDS edited by Edison Trickett and Willo Pequegnat, pp. 153–175. Oxford, UK: Oxford University Press.
  • Singer, Merrill and Bulled, Nicola 2013 Interlocked Infections: The Health Burdens of Syndemics of Neglected Tropical Diseases. Annals of Anthropological Practice 36(2):326-344.
  • Solomon, T., Halkitis, P., Moeller, R., Siconolfi, D., Kiang, M., and Barton, S. 2011 Sex Parties among Young Gay, Bisexual, and Other Men Who Have Sex with Men in New York City: Attendance and Behavior. Journal of Urban Health[in press]
  • Southgate, Erica, Weatherall, Anne Marr, Day, 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 4:5.
  • 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. Presented at the American Public Health Association meetings, Washington, D.C. Abstract #155854. Abstract available online at: http://apha.confex.com/apha/135am/techprogram/paper_155854.htm.
  • 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., and 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): 939-942.
  • Stall, Ron and Mills, Thomas 2006 Health Disparities, Syndemics and Gay Men’s Health. Presented at the Center for Health Intervention and Prevention. University of Connecticut. Available online at: http://www.chip.uconn.edu/lec/Stall%20-%20Connecticut%20Talk.pdf.
  • 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-S127.
  • 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. 3 134-148.
  • 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. and 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 2011 (in press) doi:10.1007/s11524-011-9563-8.
  • Talman, Anna, Bolton, Susan, and Walson, Judd 2012 Interactions Between HIV/AIDS and the Environment: Toward a Syndemic Framework. American Journal of Public Health 103(2):253-261.
  • Tezal, Mine 2012 Interaction between Chronic Inflammation and Oral HPV Infection in the Etiology of Head and Neck Cancers. International Journal of Otolaryngology 2012 Article ID 575242 http://dx.doi.org/10.1155/2012/575242.
  • Tian, Li-Guang, Wang, Tian-ping, Lv, Shan, Wang, Feng-Feng, Guo, Jian, Yin, Xiao-Mei, Cai, Yu-Chun, Dickey, Mary, Steinmann, Peter and Chen, Jia-Xu 2013 HIV and intestinal parasite co-infections among a Chinese population: an immunological profile. Infectious Diseases of Poverty 2:18 doi:10.1186/2049-9957-2-18.
  • Tieu, Van and Koblin, B. 2009 HIV, Alcohol, and Noninjection Drug Use. Current Opinion in HIV AIDS 4(4):314-318.
  • Tobian, Aaron and Quinn, Thomas 2009 Herpes simplex virus type 2 and syphilis infections with HIV: An evolving synergy in transmission and prevention. Current Opinion in HIV and AIDS 4(4):294-299.
  • Thuy,T., Shah, N, Hoang Anh, M.H, Nghia, D.T., Thom, D., Linh, T., Sy, D.N., Duong, B.D., Chau, L.T.M., Mai, P.T.P., Wells, C., Laserson, K. and Varma, J.K. 2007 HIV-Associated TB in An Giang Province, Vietnam, 2001–2004: Epidemiology and TB Treatment Outcomes. PLoS ONE 2(6: e507. Online at: http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal.pone.0000507.
  • van Lettow, M., Fawzi, W., and Semba, R. 2003 Triple Trouble: The Role of Malnutrition in Tuberculosisand Human Immunodeficiency Virus Co-infection. Nutrition Reviews 61(3): 81-90.
  • van Zyl-Smitt, Richard, Brunet, Laurence, Madhukar, Pai and Yew, Wing-Wai 2010 The Convergence of the Global Smoking, COPD, Tuberculosis, HIV, and Respiratory Infections Epidemics. Infectious Disease Clinics of North America 24:693-703.
  • van Zyl-Smitt, Richard, Madhukar, Pai and Yew, Wing-Wai, Leunig, C., Zumla, E., Bateman, E. and Dheda, L. 2010 Global Lung Health. The Colliding Epidemics of Tuberculosis, Tobacco Smoking, HIV and COPD. European Respiratory Journal 35(1):27-33.
  • Ventura, H. and Mehra, M. 2004 The Growing Burden of Health Failure: The "Syndemic" is Reaching Latin America. American Heart Journal 147(3): 412-417.
  • Vogenthaler, Nicholas, Hadley, Craig, Rodriguez, Allan, Valverde, Eduardo, del Rio, Carolos, Metsch, Lisa 2010 Depressive Symptoms and Food Insufficiency Among HIV-Infected Crack Users in Atlanta and Miami. AIDS and Behavior 15(7):1520-1526.
  • Yu, F., Nehl, E., Zheng, T., He, N., Berg, C., Lemieux, A., Lin, L., Tran, A., Sullivan, P. and Wong, F. 2013 A syndemic including cigarette smoking and sexual risk behaviors among a sample of MSM in Shanghai, China. Drug and Alcohol Dependence doi: 10.1016/j.drugalcdep.2013.02.016.
  • Walkup, James, Blank, Michael, Gonzalez, Jeffrey, Safren, Steven, Schwartz, Rebecca, Brown, Larry, Wilson, Ira, Knowlton, Amy, Lombard, Frank, Grossman, Cynthia, Lyda, Karen, and Schumacher, Joseph 2008 The Impact of Mental Health and Substance Abuse Factors on HIV Prevention and Treatment. Journal of Acquired Immune Deficiency Syndrome 47(Supplement 1): S15-S19.
  • Wallace R. A 1988 Synergism of Plagues. Environment Research 47:1-33.
  • Wang, C., Yang, C., Chen, H., Chuang, S., Chong, I., Hwang, J., and Huang, M. 2008 Impact of type 2 diabetes on manifestations and treatment outcome of pulmonary tuberculosis. Epidemiology and Infection 137(2):203-210.
  • Wasserheit, J. 1992 Epidemiological synergy. Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sexually Transmitted Disease 19:61-77.
  • Weaver, Lesley Jo and Mendenhall, Emily 2013 Applying Syndemics and Chronicity: Interpretations from Studies of Poverty, Depression, and Diabetes. Medical Anthropology (in press) DOI:10.1080/01459740.2013.808637.
  • Wim, Vanden Berghe and Laga Marie Nöstlinger Christiana 2013 Syndemic and Other Risk Factors for Unprotected Anal Intercourse Among an Online Sample of Belgian HIV Negative Men Who have Sex with Men. AIDS and Behavior (published online) DOI 10.1007/s10461-013-0516-y.
  • Workman, Cassandra 2013 A Critical Ethnography of Globalization in Lesotho, Africa: Syndemic Water Insecurity and the Micro-politics of Participation. Doctoral Dissertation, Department of Anthropology, University of South Florida.
  • Young, C., Ann 2004 A Syndemic Perspective on Whooping Cough Epidemics at York Factory. Presented at the Canadian Association for Physical Anthropology, London, Ontario, Canada.
  • Young, Fiona, Critchley,Julia, Johnstone, Lucy and Unwin, Nigel 2009 A review of co-morbidity between infectious and chronic disease in Sub Saharan Africa: TB and Diabetes Mellitus, HIV and Metabolic Syndrome, and the impact of globalization. Globalization and Health5: 9 doi: 10.1186/1744-8603-5-9.
  • Yu, F. 2012 Smoking Syndemics among a Sample of Men Who Have Sex with Men in Shanghai, China. Master's Thesis Emory University.
  • 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): 388-389.

External links[edit]