The role of the intimate partner violence, HIV, and substance abuse syndemic in women's mental health

Intimate partner violence (IPV), HIV/AIDS and substance abuse have significant individual effects on women's health, but their synergistic, or syndemic, effect on women's mental health is unknown. This dissertation aims to evaluate the impact of the Substance Abuse, IPV and HIV/AIDS (SAVA) syndemic on depressive symptoms among urban women and investigate social support as an influential factor on mental health outcomes.;A synthesis of existing literature suggests that the SAVA factors co-occur among women and that sex work and unstable housing are critical contexts in which the SAVA syndemic manifests. Depression and other mental illnesses are identified as important related health outcomes.;A quantitative analysis was conducted on data from 445 low-income urban women. IPV, HIV, hard drug use, and low social support were independently associated with depressive symptoms. IPV, recent hard drug use and high social support were associated with depressive symptoms in adjusted analyses. The interaction between HIV and IPV was marginally significant, suggesting a synergistic effect on depression. However, social support did not modify the effect of the SAVA factors on depression. Compared to women who experienced no SAVA factors, women who experienced all three were 6.77 times more likely to have depressive symptoms.;In-depth interviews were conducted with 24 HIV-positive women who had experienced IPV and used hard drugs. Resulting qualitative data were analyzed to investigate the nature of the SAVA syndemic on depression and ways in which women access social support to address these health problems. Women described multiple SAVA factors as catalysts for their depression and noted synergistic effects of factors on their depressive symptoms. Depression was described as both a trigger for and result of drug use. Further, women access numerous sources of social support, but the types of sources accessed to address each SAVA factor and associated depression varied.;Findings from this research indicate that IPV, HIV/AIDS and substance abuse co-occur and overlap in the lives of urban women, and have detrimental syndemic impact on their mental health. Formal and informal social support are important resources for women experiencing the SAVA syndemic and could be improved by adopting a syndemics theory approach.