Bibliography on Syndemics of HIV, STIs, TB, Hepatitis, Mental Health and Psychosocial Issues and Substance Abuse – Version 1 (11/28/2018)

Heartland Alliance International Annotated Bibliography – 
Version 1 (11/28/2018)

The Evidence Base for Comprehensive Services for Key Populations: Addressing Stigma, Violence and Mental Health

Clint Trout, MA, MPH, DrPH, Nana Sang-Bender, MSW, Rohan Goyal



Introduction: Many studies have shown that key populations, including men who have sex with men, female sex workers, persons who inject drugs and transgender men and women face stigma, violence and discrimination as well as suffer from high rates of mental health/psychosocial issues and substance abuse. However, services to address these issues for key populations remain under resourced.

Methods: We did a search of the literature to summarize the evidence base for comprehensive services addressing key populations’ varying needs. We divided the studies and reviews by geography into HAI focus countries, systematic reviews, West and Central Africa, Northern, Southern and Eastern Africa, other low and middle-income contexts, and high-income contexts.

Results: We located studies related to eight themes: 1. Syndemics (19 studies inc. 3 systematic reviews/meta-analyses); 2.  High prevalence of trauma, mental health issues and substance abuse among key populations (64/8); 3. Trauma and how it increases HIV transmission risk (35/5); 4. Associations of trauma with mental health/psychosocial problems (34/5); 5. How trauma and its effects are important barriers to access to HIV services, adherence and viral load suppression (43/13); 6. Associations of mental health and cognitive problems with HIV infection itself (17/3); 7. Needs of female key populations for reproductive health and rights services (12/1); and 8. Results of programming models to address these issue, including improved adherence to ART and viral load (38/12). The studies in this bibliography are not comprehensive by any means and we will continue to update it periodically.

Conclusion: Strong evidence exists to suggest that reaching the UNAIDS 90/90/90 (90% of HIV-positives know their status, 90% of people with HIV are on antiretroviral therapy, and 90% of patients on antiviral therapy reach viral load suppression) among key populations will require programming to mitigate the impact of trauma.

A strong evidence base exists to support the following conclusions:

  1. Worldwide HIV epidemics among key populations (and other groups) are, in fact, “syndemics” of coinfections of sexually transmitted infections, HIV, violence, neglect and abuse in childhood, adolescence and adulthood, mental health and psychosocial problems, substance abuse and other social factors, including criminalization and lack of access to quality services. (19 studies inc. 3 systematic reviews/meta-analyses)  (Table 1)
  2. Key populations suffer high rates of trauma, mental health and psychosocial issues. (64 studies inc. 8 systematic reviews/meta-analyses) ( (Table 2)
  3. Experience of trauma, mental health, gender, and substance use substantially increase HIV risk among key populations and men and women in the general population. (54 studies inc. 12 systematic reviews/meta-analyses) (Table 3)
  4. Experiences of trauma are associated with higher mental and psychosocial health issues including substance abuse among key populations and men and women in the general population. (34 studies inc. 5 systematic reviews/meta-analyses) (Table 4)
  5. Experience of trauma, drug use, stigma and mental health issues associated with lower uptake of and success in HIV services including HIV testing, treatment, adherence and viral load suppression among key populations and men and women in the general population. (43 studies inc. 13 systematic reviews/meta-analyses) (Table 5)
  6. HIV infection itself is associated with higher mental health and psychosocial issues(17 studies inc. 3 systematic reviews/meta-analyses) (Table 6)
  7. Female key populations have elevated need for linkages to family planning, PMTCT and OVC services. (12 studies inc. 1 systematic review/meta-analysis) (Table 7)
  8. Programs that integrate mental health and psychosocial services, access to justice, community empowerment and GBV services within HIV services show improved results relevant to HIV transmission and treatment. (38 studies inc. 12 systematic reviews/meta-analyses) (Table 8)

View full report: HAI HIV KP Annotated Bibliography v1 112818

For more information, contact Clint Trout at