Syndemic conditions associated with hazardous alcohol consumption among sexual minority men in San Francisco

Background: Hazardous alcohol consumption (HAC) is prevalent among sexual minority men (SMM). Using syndemic theory, this study aimed to identify the number of syndemic conditions, including their combinations, and their association with HAC among SMM in San Francisco. Method: We conducted a secondary analysis of cross-sectional data from 246 SMM who consume alcohol. Syndemic factors included multiple substance use, depressive symptoms, HIV/STI status, and houselessness. We conducted a multivariable logistic regression to estimate the odds of HAC associated with increasing syndemic conditions. We further examined which combinations of three syndemic factors were associated with the highest odds for HAC. Results: The average age was 40.7; participants were predominantly White (33.3 %) and Black/African American (29.7 %) and graduated from high school (92.7 %). The prevalence of HAC increased with the number of syndemic conditions: 13.6 % with none, 30.9 % with one, 51.9 % with two, 65.1 % with three, and 69.2 % with four conditions. A significant log-linear trend was observed, with two syndemic conditions increasing the odds of HAC over fivefold (AOR=5.05, 95 % CI=1.68-15.15), and three and four syndemic conditions increasing the odds by more than eightfold (AOR=8.82, 95 % CI=2.74-28.39; AOR=8.55, 95 % CI=2.26-32.28). The combination of depressive symptoms, HIV/STI status, and houselessness tripled the odds for HAC (OR=3.07, 95 % CI=1.34-7.04). Conclusion: HAC was associated with increasing syndemics, and specific conditions (depression, HIV/STI, and houselessness) had the greatest odds of HAC. These findings underscore the need for comprehensive screening and integrated interventions targeting these co-occurring conditions to reduce HAC in this population.