Award Date

5-15-2026

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Committee Member

Lung-Chang Chien

Second Committee Member

Ying Guo

Third Committee Member

Jennifer Pharr

Fourth Committee Member

Nicole Short

Number of Pages

86

Abstract

The SAVA syndemic highlights the interconnected and mutually reinforcing nature of substance use, violence victimization, and HIV/AIDS. The synergistic interaction of these conditions creates structural and behavioral barriers that disrupt the HIV care continuum and contribute to significant health inequities. Achieving a suppressed viral load is a critical clinical outcome for people living with HIV, while viral non-suppression can be an indicator of poor health, elevated transmission risk, and disease progression. Still, the association between SAVA factors and viral suppression/non-suppression outcomes within U.S. populations remains inconsistently characterized due to heterogeneous methodologies and variable inclusion of high-risk groups. This mixed-methods study conducted a scoping review and meta-analysis of U.S.-based literature from 2000 to 2026, which examined SAVA syndemic factors and HIV viral load outcomes. Thematic analysis of 18 studies supported the co-occurring and mutually reinforcing nature between substance use and violence victimization and highlighted the compounded burden on clinical outcomes. Moreover, findings characterized a shifting landscape, in which other social, structural, and psychological conditions are incorporated into the syndemic. Although the inclusion of high-risk sub-groups was moderate, intersectional frameworks remain underexplored. Exploratory meta-analyses of 8 studies highlighted a significant inverse association between substance use and viral non-suppression only (OR = 0.49, 95% CI [0.26, 0.72], p < .001), noting moderate heterogeneity among studies. Sensitivity analyses highlight the influential nature of one study skewing results for the violence meta-analysis towards the null. These findings bridge thematic and quantitative analysis to comprehensively map evidence on SAVA syndemic exposure and clinical outcomes and to synthesize quantitative associations when feasible.

Keywords

HIV; SAVA syndemic; Viral load

Disciplines

Biostatistics | Epidemiology | Public Health

File Format

PDF

File Size

1939 KB

Degree Grantor

University of Nevada, Las Vegas

Language

English

Rights

IN COPYRIGHT. For more information about this rights statement, please visit http://rightsstatements.org/vocab/InC/1.0/

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