Syndemic Analysis of People Living with HIV/AIDS in North Carolina

Background: In the United States, HIV and STDs have become syndemic due to shared modes of transmission and social determinants of health.  However, there are few studies that have described the extent of disease overlap in the Southeastern US.  In North Carolina, HIV, early syphilis, gonorrhea, chlamydia, and viral hepatitis B are reportable conditions, and as of November 2012 all reports are managed in one fully-integrated surveillance system.

Methods: Nine legacy surveillance systems were converted into the North Carolina Electronic Disease Surveillance System (NCEDSS).  Persons in NCEDSS with more than one disease were identified, matched, merged, and de-duplicated to create a single comprehensive view of each reportable event.  Descriptive analyses were performed on HIV-positive individuals with and without syndemic infections using SAS 9.3.

Results: From 1984 to 2013, 48,285 cases of HIV/AIDS were reported in North Carolina; 35,136 (72.8%) were male, 31,811 (65.9%) were black, and 2,252 (4.7%) were Hispanic.  Among HIV-positive males, 6,195 (17.6%) had at least one syndemic infection: 12.5% with syphilis, 6.2% with gonorrhea, 2.9% with chlamydia, and 2.5% with chronic hepatitis B. Among women, 1,514 (11.5%) had at least one syndemic infection: 7.0% with syphilis, 3.3% with gonorrhea, 3.1% with chlamydia, and 1.1% with chronic hepatitis B.  Syndemic infections were commonly (43.8%) reported at least one year after the initial HIV diagnosis.

Conclusions: Our findings highlight the extent of disease overlap in NC and the need for improved STD prevention and control among HIV-positive individuals.  The high concurrence of co-infections at least one year after HIV diagnosis indicates that initiatives aimed at better educating HIV-positive individuals on STD prevention are necessary to control HIV/STD syndemics in North Carolina.