The Syndemic Approach to HIV, STI, Hepatitis, and Harm Reduction

Apr 19, 2023

NACCHO works with local health departments to address HIV, STIs, viral hepatitis, and harm reduction collaboratively. These public health challenges represent a syndemic in the United States—a phenomenon in which two or more diseases or health conditions and the social contexts in which they occur coincide and exacerbate one another, resulting in worse outcomes such as increased transmission, morbidity, and mortality. In other words—two diseases or conditions occur among the same populations and make each other worse.

The syndemic of HIV, STIs, viral hepatitis, and overdose (as well as other substance use-related harms) is characterized by dramatic increases in STIs, hepatitis, and overdose, as well as outbreaks of HIV:

  • HIV outbreaks among people who use drugs have been reported in at least 10 jurisdictions since 20151,2,3,4,5
  • STI case rates are at record high levels, as are negative outcomes of untreated STIs, such as congenital syphilis6
  • Hepatitis C cases increased 5-fold since 2010; since 2016, more than 37 US states experienced hepatitis A outbreaks, and progress against Hepatitis B has stalled7 · More than 100,000 fatal overdoses occurred over the course of the year ending in April 20218

Addressing these trends requires a syndemic approach, which includes:

  • Addressing these public health challenges collaboratively (e.g., through the integration of services)
  • Prioritizing populations that are inequitably impacted by the syndemic when designing public health services and interventions
  • Addressing the shared social determinants (e.g., poverty, housing, employment, involvement with the criminal justice system) and shared barriers to accessing health services (e.g., affordability, transportation, stigma and discrimination)

Our Work:


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