This paper measures syndemic substance use disorder, violence, and mental health and compares the syndemic among HIV-infected heterosexual men, heterosexual women, and men who have sex with men (MSM). Data were from a sample of high needs substance-using, HIV-infected people in South Florida between 2010 and 2012 (n = 481). We used confirmatory factor analysis to measure a syndemic latent variable and applied measurement invariance models to identify group differences in the data structure of syndemic co-morbidities among heterosexual men, heterosexual women, and MSM. We found that variables used to measure the syndemic fit each sub-group, supporting that substance use disorder, violence, and mental health coincide in HIV-infected individuals. Heterosexual men and MSM demonstrated similar syndemic latent variable factor loadings, but significantly different item intercepts, indicating that heterosexual men had larger mean values on substance use disorder, anxiety, and depression than MSM. Heterosexual men and heterosexual women demonstrated significantly different syndemic variable factor loadings, indicating that anxiety and depression contribute more (and substance use contributes less) to the syndemic in heterosexual men compared to heterosexual women. MSM and heterosexual women demonstrated similar syndemic latent variable factor loadings and intercepts, but had significantly different factor residual variances indicating more variance in violent victimization and depression for MSM and more variance in stress for heterosexual women than what is captured by the observed syndemic indicators. Furthermore, heterosexual women had a larger syndemic factor mean than MSM, indicating that the syndemic burden is greater among heterosexual women than MSM. Our findings support that measurement invariance can elucidate differences in the syndemic to tailor interventions to sub-group needs.

Document Type


Publication Date


Notes/Citation Information

Published in AIDS and Behavior, v. 21, issue 8, p. 2270-2282.

© Springer Science+Business Media, LLC 2017

The copyright holder has granted the permission for posting the article here.

This is a post-peer-review, pre-copyedit version of an article published in AIDS and Behavior. The final authenticated version is available online at: https://doi.org/10.1007/s10461-017-1841-3.

Digital Object Identifier (DOI)


Funding Information

This research was funded by PHS Grant Number R01DA023157 (Surratt), T32DA023356 (Tsuyuki), K01 DA036447 (Pitpitan), K01DA036439 (Urada), and K01DA031593 (Stockman) from the National Institute on Drug Abuse (NIDA), R01HD077891-04S1 (Tsuyuki) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), L60MD003701 (Stockman) from the National Institute of Minority Health and Health Disparities, and K01AA025009 (Tsuyuki) from the National Institute of Alcohol Abuse and Alcoholism (NIAAA).