# Stigma and the non-communicable disease syndemic in aging HIV positive and HIV negative MSM

> **NIH NIH R01** · RUTGERS BIOMEDICAL AND HEALTH SCIENCES · 2024 · $507,184

## Abstract

ABSTRACT
Over the next decade, more than 70% of people living with HIV (PWH) will be older than 50. The increasing
burden of the non-communicable diseases (NCDs) hypertension, diabetes, and dyslipidemia has al-ready
begun to present key challenges to effective HIV care among aging PLWH, including sexual minority men
(SMM). Because these NCDs often present together as comorbid conditions, interact with each other
adversely, and are inflected by social and structural inequities, they may comprise a synergistic epidemic
(syndemic). In the U.S., there are substantial racial, ethnic, and socioeconomic disparities in the
prevalence and/or control of NCDs and HIV. Intersecting stigmas, such as racism, classism, and
homophobia, may drive these health disparities through direct and indirect mechanisms. Directly,
intersectional stigma in healthcare settings may contribute to healthcare avoidance, decreasing success
rates along HIV and NCD syndemic continua of care domains of retention, treatment, adherence, and
disease control. Indirectly, experiencing intersectional stigma may lead to a psychosocial syndemic of stress,
depression, violence, and substance use, thereby contributing to HIV and NCD incidence, prevalence, and
poorer disease control. Very few if any studies have prospectively assessed the contribution of
intersectional stigma to social disparities in NCD syndemic incidence, prevalence, and control among
PWH; and few if any studies have rigorously assessed how the psychosocial syndemic may mediate
pathways between social position and syndemic NCD and HIV outcomes. Collecting data over a four-year
period, we will utilize the MACS/WIHS Combined Cohort Study, the longest-running cohort study of HIV+
and HIV- SMM in the U.S., to assess the following specific aims: 1) assess relationships between social
position, intersectional stigma, and the psychosocial syndemic among middle-aged and aging HIV+ and
HIV- SMM; 2) assess relationships between social position and NCD syndemic incidence and
prevalence; and 3) assess relationships between social position and HIV and NCD syndemic continua of
care outcomes, mediated by intersectional stigma and the psychosocial syndemic. Our scientific premise is
that multiply marginalized populations experience disparities in NCD syndemic incidence, prevalence, and
control, which are mediated by intersectional stigma and the psychosocial syndemic. The proposed work
will extend intersectional stigma and psychosocial syndemics research on the HIV continuum of care to the
NCD syndemic continuum of care. This proposal aligns with NIH high priority AIDS research areas outlined in
NOT-OD-15-137 (“addressing the impact of HIV-associated comorbidities”) and with NHLBI RFA-HL-21-018,
which calls for multifactorial research using syndemics frameworks to characterize clustering of heart,
lung, blood, and sleep conditions within PWH. This study will provide critical data for informing the
development of integrated, multilevel interv...

## Key facts

- **NIH application ID:** 10911221
- **Project number:** 5R01HL160326-05
- **Recipient organization:** RUTGERS BIOMEDICAL AND HEALTH SCIENCES
- **Principal Investigator:** Mackey R Friedman
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $507,184
- **Award type:** 5
- **Project period:** 2023-02-01 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10911221

## Citation

> US National Institutes of Health, RePORTER application 10911221, Stigma and the non-communicable disease syndemic in aging HIV positive and HIV negative MSM (5R01HL160326-05). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10911221. Licensed CC0.

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