Brigham Research Institute Poster Session Site logo-1
Close this search box.

Simran Khanna, BA

Job Title

Research Assistant II

Academic Rank

Staff/Research Assistant


Emergency Medicine


Simran S. Khanna, Caitlin N. Wizda, Mohammad Adrian Hasdianda, Calvin Fitch, Conall O’Cleirigh, Peter Chai, Tiffany R. Glynn

Principal Investigator

Dr. Peter Chai



Assessing Co-Occurring Psychosocial Conditions Driving HIV Risk in the Emergency Department

Scientific Abstract

Syndemic theory offers a framework to conceptualize HIV epidemics faced by marginalized communities, proposing that co-occurring psychosocial comorbidities drive HIV risk. Specifically, mental health issues, substance use, discrimination, abuse, and economic strain can compound, creating barriers to care. As a safety net, the emergency department (ED) is a promising setting to reach overlooked communities while implementing HIV prevention interventions. However, there is a paucity of research exploring the syndemic of HIV in an ED population.

We administered a quantitative, cross-sectional psychosocial assessment in the BWH and BWFH EDs to 198 participants with an indication of HIV risk behavior. Majority were BIPOC (61.6%). 18.7% were sexual minorities, and 2% were gender minorities. 86.9% reported mental health issues, 29.8% problematic substance use, 60.1% experiencing discrimination, 30.8% abuse as an adult, 34.9% abuse as a child, and 36.9% economic strain. Notably, 65.2% experienced ≥ 3 syndemic conditions, while 28.3% experienced ≥ 5.

Aligned with syndemic theory, the sample had HIV risk behavior including condomless sex (55.6%), not testing for HIV (40.9%), and unfamiliarity with PrEP (33.3%). Results elucidate the necessity of integrated care services in the ED to address the syndemic of HIV.

Lay Abstract

Experiencing multiple challenges, including mental health issues, substance use, discrimination, abuse, and insufficient income and basic needs, can lead to HIV risk. The combination of these issues can be referred to as the “syndemic” of HIV. The emergency department (ED) is potentially a valuable setting to offer care that addresses all of these issues to help prevent HIV. However, we lack research exploring how people experience these multiple issues when they come to the ED.

We administered a quantitative survey in the BWH and BWFH EDs to 198 participants. More than half the sample was BIPOC (62%). 19% were sexual minorities, and 2% were gender minorities. The sample reported HIV risk, including condomless sex (56%), not testing for HIV (41%), and not knowing about PrEP (33%). Almost everyone reported a mental health issue (87%), 39% had problematic substance use, more than half (60%) experienced discrimination, 31% reported abuse as an adult, 35% reported abuse as a child, and 37% lacked sufficient money and basic needs. Most of the sample experienced at least 3 of these issues in tandem (65%). Results show that people in the ED would benefit from having services to address the multiple challenges they face.

Clinical Implications

The ED is a valuable setting to reach marginalized communities for HIV prevention that are not receiving necessary services. Prevention efforts should transcend a focus on risk behavior, instead adopting a syndemics framework that addresses the multiple challenges individuals face.