Project summary Women with HIV (WWH) are a high priority population that faces a clustering of gender-based violence (GBV), substance use, mental health disorders, sleep disturbances, and hypertension (HTN). Studies on the syndemic of substance use, violence, and HIV/AIDS (SAVA) have shown that these factors are associated with mental health disorders and adverse HIV outcomes. However, the relationship of these syndemic factors on noncommunicable diseases in this population is not well known. HTN and sleep disturbances are common and co-occur among WWH. GBV, substance use, and mental health disorders are associated with sleep disturbances and HTN, separately, but a holistic understanding of these syndemic factors and co-morbid health outcomes is not well established, especially among WWH. A syndemic approach would facilitate the investigation of the specific pathways by which these factors interact to exacerbate co- morbid sleep disturbances and HTN. There is also increasing evidence about the important contribution of race and income, as manifested in social and neighborhood context, to this syndemic cluster. The Women’s Interagency HIV Study (WIHS) is the largest ongoing prospective study of women at risk for HIV and WWH in the US. Leveraging the resources of WIHS and building on previous SAVA- related work, the objective of this proposal is to understand how syndemic factors longitudinally impact sleep disturbances and HTN among WWH who are confronting distinct social, neighborhood, and economic realities. We also seek to clarify the interaction, mediators, and directionality linking these multi- level syndemic factors and co-morbid health outcomes. The specific aims of the proposed study are to: 1) Assess how syndemic factors (i.e., gender-based violence, substance, and depression) interact in longitudinally impacting co-morbid sleep disturbances/HTN among WWH; 2) Assess whether individual- and neighborhood-level factors related to race and income impact syndemic factors and co-morbid sleep disturbances/HTN; 3) Assess whether social network factors impact syndemic factors and co-morbid sleep disturbances/HTN. Led by an early-stage investigator, this transdisciplinary team of investigators is comprised of content and methodological experts relevant to the study. The results of the study will generate important insights for policies as well as multi-sectoral interventions to alleviate social and health inequities among WWH both in the US and worldwide.

Project Narrative: Violence, substance use, sleep disturbances, and hypertension among women with HIV: A syndemic approach (VS2H2 Syndemic) Leveraging the resources of Women’s Interagency HIV study and building on previous work related to the syndemic of substance abuse, violence, and HIV/AIDS, the objective of this proposal is to understand how syndemic factors longitudinally impact sleep disturbances and hypertension among women with HIV (WWH) who are confronting distinct social, neighborhood, and economic realities. We also seek to clarify the interaction, mediators, and directionality linking these multi-level syndemic factors and co-morbid health outcomes. The results of the study will generate important insights for policies and multi-sectoral interventions to alleviate social and health inequities among WWH both in the US and worldwide.