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An Update on Syndemics

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A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366).

Deadline for manuscript submissions: closed (30 November 2024) | Viewed by 13594

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Special Issue Editors

Dr. Nicola Bulled

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Guest Editor

Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
Interests: syndemics; HIV; biopolitics; refugee integration
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Merrill Singer

*
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Guest Editor

Department of Anthropology, University of Connecticut, 354 Mansfield Road, Unit 1176, Storrs, CT 06269-1176, USA
Interests: syndemics; ecosyndemics; climate change
* We dedicate the memory of the editor, Prof. Dr. Merrill Singer, who passed away during this special issue period.
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The theory of syndemics hypothesizes that observed clusters of diseases in specific temporal and geographical contexts are the result of harmful socio-environmental conditions resulting in mutually enhancing deleterious consequences. For the past 25 years, the concept has informed an array of health-related disciplines, proving valuable in health research, policy, and practice.

This Special Issue aims to highlight new syndemic arrangements of infectious diseases in order to inform health policy and interventions. While HIV-related syndemics remain the most studied, new disease arrangements related to COVID-19 and other epidemics (e.g., SARS, Zika, Ebola, dengue, chikungunya, mucormycosis) have emerged that warrant investigation. Furthermore, while epidemics may transcend national borders, driven by analogous influencing social factors, syndemic factors take on unique arrangements in different social, political, economic, and geographic contexts. Place-based assessments are much needed to develop context-specific solutions.

For this Special Issue, we ask scholars working in the field to consider novel syndemic attributes of clusters of infectious diseases that result in worse health outcomes than each condition in isolation. Topics of interest include, but are not limited to, the following: (1) infectious diseases and other health conditions concentrated in a population; (2) the health conditions interacting biologically; and (3) social conditions interacting with health conditions in a manner that increases infectivity or disease progression.

Scholars are asked to present evidence of the observed syndemic, clearly addressing all three dimensions of syndemic theory (biological factors, social factors of populations affected, and synergistic interaction). Manuscripts are not limited to specific methods (qualitative, quantitative, or mixed) but should address how the findings inform effective public health control strategies beyond those currently employed and address novel syndemic arrangements.

Dr. Nicola Bulled
Prof. Dr. Merrill Singer
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Tropical Medicine and Infectious Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

infectious diseases
syndemics
tropical disease
social determinants of health
policy
intervention
global health

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Published Papers (9 papers)

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Editorial

Jump to: Research, Review

5 pages, 161 KiB

Open AccessEditorial

An Update on Syndemics: Editorial Comments

by Nicola Bulled and Merrill Singer

Trop. Med. Infect. Dis. 2025, 10(7), 187; https://doi.org/10.3390/tropicalmed10070187 - 2 Jul 2025

Viewed by 36

Abstract

(This article belongs to the Special Issue An Update on Syndemics)

Research

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15 pages, 516 KiB

Open AccessArticle

Occupational Syndemics in Farmworkers in the Cape Winelands, South Africa

by Nicola Bulled

Trop. Med. Infect. Dis. 2025, 10(7), 179; https://doi.org/10.3390/tropicalmed10070179 - 24 Jun 2025

Cited by 1 | Viewed by 207

Abstract

Occupational exposures in the agricultural industry globally have been associated with heightened risk for several diseases. Reports written in South Africa in the last decade have raised awareness of the harsh occupational conditions and human rights abuses suffered by farmworker communities in the wine industry. Despite receiving “fair trade” labels upon reentry into the global market in the 1990s, the working conditions on wine farms in South Africa have remained unchanged and exploitative for centuries. Farmworkers remain dependent on substandard farm housing, have insecure land tenure rights, are exposed to toxic pesticides, are denied access to benefits and unionization, and endure long working hours in harsh environmental conditions with low pay. These occupational conditions are linked to interacting disease clusters: metabolic syndrome, problematic drinking, and communicable diseases including tuberculosis, HIV, and COVID-19. This milieu of interacting diseases with deleterious outcomes is an under-considered occupational syndemic that will likely worsen given both the lasting impacts of COVID-19 and more recent shifts in global public health funding. Full article

(This article belongs to the Special Issue An Update on Syndemics)

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19 pages, 1529 KiB

Open AccessArticle

Assessing the 1918/19 Pandemic Influenza and Respiratory Tuberculosis Interaction in Malta: Operationalizing a Syndemic During a Crisis Event

by Lianne Tripp, Larry A. Sawchuk and Charles J. Farrugia

Trop. Med. Infect. Dis. 2025, 10(6), 149; https://doi.org/10.3390/tropicalmed10060149 - 24 May 2025

Cited by 1 | Viewed by 945

Abstract

Studies have indicated that there was a disease interaction of pandemic influenza with respiratory tuberculosis (TB) in Malta, which could explain the heightened mortality recorded in young adults. We revisit the 1918/19 influenza and TB syndemic potential on the island of Malta. Borrowing from crisis studies that explore the harvesting effect, we used the method of assessing changes in pre-pandemic, pandemic, fallow, and post-pandemic mortality/life expectancy to reveal the syndemic experience. Pre-pandemic (1914–1917) life expectancy at birth was significantly higher, at 37.91 years, than during the pandemic (1918), when life expectancy dropped to 33.26 years (Z = 10.56, p < 0.0001). Post-pandemic (1919) life expectancy rose to 43.49 years, which was an even longer life expectancy than pre-pandemic (Z = 17.61, p < 0.0001). There were significant changes in TB mortality death rates during the four periods in those of reproductive age. Augmenting our framework for studies of syndemics involving short-term events, we proposed the identification of contributing, driving, and limiting factors. Underlying living conditions contributed to the syndemic. The exacerbation of housing conditions, the economy associated with the First World War, and meteorological measures—temperature, relative humidity, and rainfall—were driving factors. The early implementation of mitigation strategies, such as restrictions on mass gatherings, were limiting factors of the syndemic. Full article

(This article belongs to the Special Issue An Update on Syndemics)

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12 pages, 574 KiB

Open AccessArticle

Serious Bacterial Infections and Hepatitis C Virus Among People Who Inject Drugs: A Syndemic or Intertwined Epidemics?

by Thomas J. Stopka, Robin M. Nance, L. Sarah Mixson, Hunter Spencer, Judith I. Tsui, Judith M. Leahy, Mai T. Pho, Jean DeJace, Judith Feinberg, April M. Young, Wei-Teng Yang, Amelia Baltes, Eric Romo, Randall T. Brown, Kerry Nolte, William C. Miller, William A. Zule, Wiley D. Jenkins, Joseph A. Delaney and Peter D. Friedmann

Trop. Med. Infect. Dis. 2025, 10(1), 17; https://doi.org/10.3390/tropicalmed10010017 - 9 Jan 2025

Cited by 1 | Viewed by 1400

Abstract

Limited research has examined the possible synergistic interrelationships between serious bacterial infections (SBIs) of the heart (i.e., endocarditis), bone, spine, brain, or joints (e.g., osteomylelitis) and hepatitis C virus (HCV) infections. We examined whether syndemic interactions existed between SBI, HCV, and substance-use-related factors in rural communities, hypothesizing that injection-mediated risks elevated the likelihood for both SBIs and HCV infections, which could be exacerbated by synergistic biological–biological or biological and social interactions. We calculated the prevalence ratios (PRs) of past-year SBI associated with each risk factor in separate models. Effect modification among significant risk factors was assessed using multiplicative interaction. Among 1936 participants, 57% were male and 85% White, with a mean age of 36 years. Eighty-nine participants (5%) reported hospitalization for an SBI in the year prior to the survey. More than half tested HCV-antibody-positive (58%); 62 (5.6%) of the participants with a positive HCV antibody result reported past-year hospitalization with an SBI. Injection behaviors were correlated with other SBI risk factors, including multiple injections in the same injection event (MIPIE), injection equipment sharing, and fentanyl use. In adjusted models, MIPIE (PR: 1.79; 95% confidence interval [CI]: 1.03, 3.11) and fentanyl use (PR: 1.68; 95% CI: 1.04, 2.73) were significantly associated with past-year SBI. Our analyses pointed to co-occurring epidemics of SBI and HCV, related to the cumulative health effects of fentanyl use contributing to frequent injections and MIPIE. Both the SBI and HCV epidemics present public health challenges and merit tailored interventions. Full article

(This article belongs to the Special Issue An Update on Syndemics)

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24 pages, 3407 KiB

Open AccessArticle

Gender and Intersecting Barriers and Facilitators to Access the HIV Cascade of Care in Manitoba, Canada, Before and During the COVID-19 Pandemic: A Qualitative Study

by Enrique Villacis-Alvarez, Cheryl Sobie, Katharina Maier, Margaret Lavallee, Chantal Daniels, Heather Pashe, Joel Baliddawa, Nikki Daniels, Rebecca Murdock, Robert Russell, Clara Dan, Freda Woodhouse, Susie Cusson, Lisa Patrick, Marj Schenkels, Michael Payne, Ken Kasper, Lauren J. MacKenzie, Laurie Ireland, Kimberly Templeton, Kathleen Deering, Margaret Haworth-Brockman, Yoav Keynan and Zulma Vanessa Rueda Show full author list Hide full author list

Trop. Med. Infect. Dis. 2024, 9(12), 287; https://doi.org/10.3390/tropicalmed9120287 - 25 Nov 2024

Cited by 3 | Viewed by 1989

Abstract

Marginalized groups in Manitoba, Canada, especially females and people who inject drugs, are overrepresented in new HIV diagnoses and disproportionately affected by HIV and structural disadvantages. Informed by syndemic theory, our aim was to understand people living with HIV’s (PLHIV) gendered and intersecting barriers and facilitators across the cascade of HIV care before and during the COVID-19 pandemic. This study was co-designed and co-led alongside people with lived experience and a research advisory committee. We employed semi-structured interviews with thirty-two participants and three questionnaires. Interviews were audio-recorded, transcribed, and coded, and descriptive statistics were performed on the first two questionnaires. Qualitative data analysis used thematic analysis and focused on identifying categories (individual, healthcare, and social/structural) related to the barriers and facilitators to HIV care. A total of 32 PLHIV completed this study and over 70% of females and 50% of males reported severe and moderate sexual abuse among other traumatic childhood experiences. Barriers to accessing or continuing in the cascade of HIV care included navigating the initial shock of receiving an HIV diagnosis, mental health challenges and inaccessible supports, substance use, violence (including intimate partner), internalized and enacted compounded stigma related to houselessness and substance use, discrimination by primary care service providers and social networks, lack of preventative and social supports, lack of accessible housing, and programmatic issues. COVID-19 increased mental health problems and disrupted relationships with HIV service providers and peers living with HIV. Facilitators to HIV care included stopping substance use, caring service providers particularly during HIV diagnosis, welcoming healthcare environments, social opportunities and integrated supports, and supportive social networks. Women, men, and non-binary PLHIV experience interconnected factors complicating their experiences with HIV care. Interventions should consider holistic, person-centered, and trauma-informed care options to address the barriers found in this research and appropriately serve PLHIV. Full article

(This article belongs to the Special Issue An Update on Syndemics)

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24 pages, 2732 KiB

Open AccessArticle

‘The Lost Peace’: Evidencing the Syndemic Relationship between Neglected Tropical Diseases and Mental Distress in Liberia

by Rosalind McCollum, Carrie Barrett, Georgina Zawolo, Rachel Johnstone, Tiawanlyn G. Godwin-Akpan, Hannah Berrian, Shahreen Chowdhury, Jerry Kollie, Karsor Kollie, Emerson Rogers, Colleen Parker, Maneesh Phillip, Lucas Sempe, Maaike Seekles, John Solunta Smith, Wede Seekey, Anna Wickenden, Zeela Zaizay, Sally Theobald and Laura Dean

Trop. Med. Infect. Dis. 2024, 9(8), 183; https://doi.org/10.3390/tropicalmed9080183 - 17 Aug 2024

Cited by 3 | Viewed by 2056

Abstract

Neglected Tropical Diseases (NTDs) are a group of chronic infectious diseases of poverty affecting over one billion people globally. Intersections of NTDs, disability, and mental ill-health are increasingly evidenced but are rarely studied from a mixed-methods perspective. Here, we advance syndemic understandings by further assessing and contextualising the syndemic relationship between NTDs (particularly their associated disability) and mental distress in Liberia. Participatory qualitative methods, including body mapping (56 participants), social mapping (28 participants), and in-depth interviews (12) provided space for persons affected by NTDs to narrate their experiences. Simultaneously, 201 surveys explored experiences of common mental health conditions among persons affected by skin NTDs. An intersectionality approach was applied within the analysis for both qualitative and quantitative methods informed by Meyer’s minority stress model, adapted for NTDs. Qualitative data was analysed thematically and gender-disaggregated, univariable and multivariable analyses were applied to survey data for the outcome measures depression (PHQ-9) and anxiety (GAD-7). Disability was associated with higher levels of depression and anxiety (p < 0.001). An interaction between disability and being a women increased incidence risk ratio of depression (p < 0.001). In alignment with qualitative findings, persons affected experienced additional generalised (financial concerns), external (experience of stigma) and internal (experience of pain and physical symptoms) minority stressors, to varying degrees, which contributed towards their mental distress, and mental health conditions. These findings were used to co-develop a syndemic-informed person-centred health system response to address the suffering associated with NTDs and mental distress, including a focus on strengthening relationships between formal and informal community health actors and the broader health system. Full article

(This article belongs to the Special Issue An Update on Syndemics)

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23 pages, 1606 KiB

Open AccessArticle

Addressing the Syndemic Relationship between Lymphatic Filariasis and Mental Distress in Malawi: The Potential of Enhanced Self-Care

by Carrie Barrett, John Chiphwanya, Dorothy E. Matipula, Janet Douglass, Louise A. Kelly-Hope and Laura Dean

Trop. Med. Infect. Dis. 2024, 9(8), 172; https://doi.org/10.3390/tropicalmed9080172 - 31 Jul 2024

Cited by 3 | Viewed by 2044

Abstract

Lymphatic filariasis (LF) causes disfiguring and disabling lymphoedema, which can lead to mental distress and requires life-long self-care treatment. This study applies syndemic theory to understand the biosocial relationship between LF and mental distress in Malawi. Using in-depth qualitative methods, we critically evaluate experiences of mental distress and LF through 21 life-history interviews, to narrate experiences from the perspective of persons affected by LF, and to understand how enhanced self-care (ESC) for lymphoedema management disrupts the syndemic relationship. Complementary key informant interviews with Ministry of Health LF programme staff were conducted to further understand intervention and health system delivery. All interviews were recorded, transcribed, and translated, and then subject to thematic analysis. Our findings suggest that for persons affected by LF in Malawi, before being trained in ESC, absent referral pathways, inequalities in healthcare provision or available treatment, and limited knowledge of the condition (LF) drove the syndemic of LF and mental distress. Distress was often exacerbated by stigma and social exclusion, and shaped by intersections of gender, generation, poverty, and extreme climate conditions. We argue that addressing the syndemic suffering associated with LF and mental distress through interventions which center the needs of persons affected is critical in effective and equitable LF care delivery. Full article

(This article belongs to the Special Issue An Update on Syndemics)

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Review

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16 pages, 1582 KiB

Open AccessReview

Convergence between Cardiometabolic and Infectious Diseases in Adults from a Syndemic Perspective: A Scoping Review

by Silvia Quiroz-Mena, Juan Gabriel Piñeros-Jimenez and Wilson Cañon-Montañez

Trop. Med. Infect. Dis. 2024, 9(9), 196; https://doi.org/10.3390/tropicalmed9090196 - 26 Aug 2024

Cited by 1 | Viewed by 1535

Abstract

Objective. Synthesize the approaches used to study the convergence between cardiometabolic and infectious diseases in adults from a syndemic perspective based on the scientific evidence available to date worldwide. Methods. Scoping review that follows the recommendations of the PRISMA statement. The protocol was registered in INPLASY202150048. The search for studies was carried out in MEDLINE, LILACS, Web of Science and Scopus. Results. Since the COVID-19 pandemic, there has been an increase in studies in the field of convergence between cardiometabolic and infectious diseases from a syndemic perspective, but only three studies were classified as true syndemics. There are weaknesses in the adherence to the elements of the syndemic theory, given a low incorporation of population measurements, and until now it has not been possible to find convincing empirical evidence that supports the bio–bio interface. Quantitative methods predominated through models focused on “sum scores”. Conclusions. Future studies should comprehensively address the elements of syndemics, review discrepancies between additive analyses versus other modeling, and incorporate the influence of large-scale social forces. The lack of these aspects distances studies from the notion of syndemic, bringing them closer to comorbidity or multimorbidity approaches. Full article

(This article belongs to the Special Issue An Update on Syndemics)

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18 pages, 632 KiB

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Using a Syndemics Perspective to (Re)Conceptualize Vulnerability during the COVID-19 Pandemic: A Scoping Review

by Yisel Hernandez Barrios, Dennis Perez Chacon, Yosiel Molina Gomez, Charlotte Gryseels, Kristien Verdonck, Koen Peeters Grietens and Claudia Nieto-Sanchez

Trop. Med. Infect. Dis. 2024, 9(8), 189; https://doi.org/10.3390/tropicalmed9080189 - 22 Aug 2024

Cited by 2 | Viewed by 1707

Abstract

Syndemics theory has been applied to study interactions between biomedical and social factors leading to the clustering of diseases. Because syndemics theory focuses on interactions that enhance risk, the concept of vulnerability is central to this approach. We conducted a scoping review to better understand how this theoretical framework helped to define, operationalize, and tackle issues of vulnerability during the COVID-19 pandemic. Original research, reviews, and opinion pieces elaborating on syndemics, vulnerability, and COVID-19, published between December 2019 and October 2022 and available from PubMed, were eligible. We analyzed 40 records and identified three framings of syndemics operating during this period: (1) interactions between COVID-19, diseases/health conditions, and specific social factors; (2) interactions between COVID-19 and social determinants of health; and (3) impacts of COVID-19 on specific populations. Emerging conceptualizations described vulnerability to COVID-19 as a systemic issue, explained the impact of COVID-19 control measures on increased vulnerability, and presented COVID-19 as a syndemic on its own. However, this theory’s potential for deepening our understanding of vulnerability during this pandemic was constrained by superficial explorations of the interactions between biomedical and social spheres, and insufficient theoretical and methodological support from the social sciences. Full article

(This article belongs to the Special Issue An Update on Syndemics)

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