Structures of risk: lived experiences of multi-syndemic clustering in the greater Boston area

People who experience structural violence are an increased risk for health conditions including HIV and Hepatitis C. Particularly they are at greater risk for experiencing known syndemic interactions between these two chronic infectious diseases. The risks are mediated bio-socially through the ways that structural inequality increases social and biological vulnerability to illness and suffering. Structural inequalities, or experiences of structural violence shape environments of risk; environments of risks increase social and biological vulnerability to the structures of risk promoting syndemic interactions between biological, behavioral, and psychological conditions. The lived experiences of people diagnosed with a combination of HIV, HCV, and mental health conditions (MHC) (e.g., mood disorders and depression) are, however, thus far understudied. Many aspects and consequences of structural violence and social suffering; poverty, homelessness, substance use, lack of access to healthcare, and structural risks for HIV, HCV, MHC and interactions between the three. Through this mixed-methods, primarily qualitative, ethnographic fieldwork with individuals in the Boston area living with HIV, HCV, or both HIV and HCV, or suffering from MHC I ethnographically explore people’s perceptions of their vulnerability to these syndemic interactions. I also investigate their experiences of being at-risk for these conditions. Through this process, I seek to illuminate individuals’ understandings of the impact structures of risk (i.e., substance use, food insecurity and unstable housing) have on lived experiences with HIV/HCV, HIV/MHC, and HCV/MHC syndemics. The perceptions of the lived realities of disease-behavioral-psychological interactions and health consequences are analyzed in the context of substance use. Substance use’s biological and social dimensions have a role in promoting syndemic interactions for each of the syndemics experienced within this population. Therefore, substance use is a syndemogenic factor because of its role as a mediator for environments of risks, and as a structural risk factor in all three of these syndemics. These interactions, and consequential health outcomes, in sufferers’ own words, enrich the landscape of syndemics research, producing a clearer picture regarding the structures of risks affecting this vulnerable group in the greater Boston area