Rates of HIV infection continue to climb among minority populations and men who have sex with men (MSM), with African American/Black MSM being especially impacted. Numerous studies have found HIV transmission risk to be associated with many health and social disparities resulting from larger environmental and structural forces. Using anthropological and social environment-based theories of resilience that focus on individual agency and larger social and environmental structures, this dissertation employed a mixed methods design to investigate resilience processes among African American/Black MSM. Quantitative analyses compared African American/Black (N=108) and Caucasian/White (N=250) MSM who participated in a previously conducted randomized controlled trial (RCT) of sexual and substance use risk reduction interventions. At RCT study entry, using past 90 day recall periods, there were no differences in unprotected sex frequency, however African American/Black MSM reported higher frequencies of days high (P Qualitative data collected among a sub-sample of African American/Black MSM from the RCT (N=21) described the men’s experiences of living with multiple health and social disparities and the importance of RCT study assessments in facilitating reductions in risk behaviors. A cross-case analysis showed different resilience processes undertaken by men who experienced low socioeconomic status, little family support, and homophobia (N=16) compared to those who did not (N=5). The dissertation concludes that resilience processes to HIV transmission risk and related health and social disparities among African American/Black MSM varies and are dependent on specific social environmental factors, including social relationships, structural homophobia, and access to social, economic, and cultural capital. Men define for themselves what it means to be resilient within their social environment. These conclusions suggest that both individual and structural-level resilience-based HIV prevention interventions are needed.

This study wants to investigate how Interaction Design techniques can contribute to giving meaning to data visualization in a syndemic dashboard and to gain understanding from it. I am going to present to you a Syndemic Dashboard that has the goal of helping researchers to find trends, patterns and make predictions of the spread of Covid-19 in the Swedish context, collaborating with K3, IUR, DVMT, and the University of Oxford. In order to do this, I will first give an overview of what a dashboard is, dashboarding practices and interaction techniques, cognitive aspects involved to generate meaning, and relevant theories to gain understanding from Big Data. Consequently, I will explain the process and the methodologies applied to achieve the final result. The thesis ends with a discussion about the final result and proposes future investigations.

Individuals infected with HIV through heterosexual contact made up 24% (9,578) of all new infections in the United States. Female sex workers are at increased risk of getting HIV and other sexually transmitted infections (STI) because they may be more likely to participate in risky sexual behaviors including sex with multiple partners and condom-less anal/vaginal sex. Guided by the syndemic theory, the purpose of this study was to explore the relationships between social and structural factors (homelessness, substance use, immigration status, and use of healthcare) and risky sexual behaviors (condom-less vaginal sex and multiple sex partners) among female sex workers while controlling for age and sexual violence. This study was conducted using a quantitative research approach with a correlational method. Multiple linear regression statistical testing was performed using data from 534 participants from the National HIV Behavioral Surveillance study. Immigration status was not significantly associated with condom-less vaginal sex or multiple sex partners. However, homelessness and substance use were positively associated with condom-less vaginal sex and multiple sex partners. In addition, utilization of healthcare was negatively associated with condom-less vaginal sex. The results from this study can increase awareness and knowledge of challenges and barriers among female sex workers living in Illinois. In addition, the results of this study may contribute to establishing baseline epidemiology of this population and guidelines on addressing the factors associated with unsafe sexual behaviors that can potentially lead to HIV and other STIs.

Pregnancy brings numerous physiological and psychosocial changes and conditions, which can include gestational diabetes mellitus (GDM), and mental health conditions, including anxiety, and mood disorders such as depression. Food insecurity, or not having access to a diet that meets needs and preferences, may make management of pregnancy complications more challenging. I examined whether or not food insecurity was associated with a greater prevalence of mental health conditions, or GDM during pregnancy. I used the biocultural and syndemics approaches to the investigate the relationships among these conditions and to understand their interactions with the larger environment. The main questions are: (1) Does pregnancy increase the risk of developing or worsening food insecurity? (2) Are there positive associations between food insecurity during pregnancy and GDM as well as mental health conditions? (3) How does food insecurity impact the management of above-mentioned issues? (4) What are the experiences of individuals who have had GDM during pregnancy? To answer these questions, I undertook a mixed methods approach that involved quantitative analysis of the Canadian Community Health Survey, as well as a survey administered to pregnant people in the city of Hamilton. I also quantitatively analyzed pre-existing focus group transcripts and conducted one-on-one interviews with pregnant and postpartum people in Hamilton. This study found that there is a syndemic interaction between food insecurity, GDM, and mental health conditions in Canada. Analysis of focus group and interview transcripts provided further insight into the complex environments that shape risk for developing one, or more of these conditions during pregnancy. These results indicate how the pregnancy experience is impacted by a multitude of factors, which can lead to increasing complication risk. / Thesis / Master of Arts (MA)

The present study investigates the self-care and health maintenance strategies undertaken by individuals from Halton Region, Ontario living with type 2 diabetes and receiving assistance from food acquisition services such as community food re-distribution centres and food banks. This qualitative research project pulls narrative and thematic interview data from 18 semi-structured one-on-one interviews analyzed with syndemic theory and social determinants of health frameworks to demonstrate how clustering non-communicable diseases and social conditions disproportionately affect those in the lowest income category, and interact with each other to exacerbate the negative health effects of each condition alone. The contributions of this study are theoretical and applied. Theoretical contributions augment existing evidence for the study of non-communicable diseases using a syndemic model. The study participants demonstrated syndemic clustering of five conditions: type 2 diabetes, food insecurity, low income, poor mental health, and activity limitation. Further, this study suggests an applied element to the syndemic model through an approach to health and diabetes care that incorporates the whole person as opposed to a single disease as a unit of care. As suggested through the findings of research participant testimony, a diabetes health care centre, in addition to traditional diabetes care, would ideally screen and offer care for the other common clustered conditions listed in the syndemic elements above. Thus, the centre would provide nutrition, physical activity, mental health, and social supports to patients. As well, it is recommended that future research contributes to prevention and treatment of non-communicable diseases through social, political, and economic in form of increasing government and healthcare supports for people living with low-income and food insecurity. / Thesis / Master of Arts (MA) / This study looks at how individuals from Halton Region, Ontario maintain their health while living with type 2 diabetes and reduced access to healthy, fresh food. The project uses interview data from 18 one-on-one interviews to demonstrate how people with low income suffer from poorer overall health. Specifically, five conditions affected the study participants’ health: type 2 diabetes, reduced access to healthy food, low income, poor mental health, and reduced financial or physical access to exercise or activities of daily living (activity limitation). To combat these conditions, this study suggests an approach to health and diabetes care that looks at the whole person. Evidence and participant suggestions indicate a diabetes health care centre that screens and offers care for other common conditions that occur such as the elements listed above, and also provides nutrition care, physical activity, and social support to patients.

The United States and South Africa, exemplars of "archsegregation," have been constituted within an arc of historical racialized delineations which began with the centering, and subsequent overrepresentation, of European maleness and whiteness as the sole definition of Man. Globally present and persistent, these racialized delineations have been localized and spatially embedded through the tools of urban planning. This arc of racialized otherness, ineffectively erased, continues to inform the racially differentiated geospatial, health, social, and economic outcomes in contemporary urban form and functions for Black communities. It is within this historical arc, and against these differentiated outcomes, that contemporary urban discourse and contestation between individuals and institutions are situated. This historical othering provides not just a racialized geo-historical contextualization, but also works to preclude the recognition of the some of the most vulnerable urban community members. As urbanists and advocates strive to co-create urban space and place with municipalities, meeting the needs of these residents is imperative. In order to meet these needs, their lived experiences, and voices must be fully recognized and engaged in the processes and programs of urban co-creation, including in digital spaces and forums. Critical to achieving recognition acknowledging and situating contemporary digital discourses between local municipalities, Black residents, and Black networks within this historically racialized arc is necessary. In doing so, explore if, and how, race, specifically Blackness, is enacted in municipal digital discourse, whether these enactments serve to advance or impede resident recognition and participation, and how Black users, as residents and social network curators, engage and respond to these municipal discursive enactments. This exploratory research is a geographically and digitally multi-sited incorporated comparison of Chicago, Illinois, and Johannesburg South Africa. Using Twitter and ethnographic data collected between December 1, 2019, and March 31, 2020, this research layers digital ethnographic mixed methods and qualitive mixed methods, including traditional ethnographic, digital ethnographic, grounded theory, social change and discourse analysis, and frame analysis to explore three research goals. First, explore the digital discursive practices and frames employed by municipalities to inform, communicate with, and engage Black communities, and, if and how, these frames are situated within a historically racialized arc. Second, identify the ways in which Black residents, in dual discursive engagements with local municipalities and their own social networks, interact and engage with the municipal frames centering on Blackness. Third, through ethnographic narratives, acknowledge the marginalized residents of the Central Business District of Johannesburg, South Africa as "agents of knowledge," with critical and valuable knowledge claims which arise from their lived experiences anchored within racialized place and space. In doing so, support the efforts of these residents in recentering the validity of their knowledge claims in the co-creation of urban place and space. Additionally, in situating the city within a historically racialized arc develop novel frameworks, the racialized palimpsest city and syndemic segregation, through which to explore contemporary urban interactions and engagements. / Doctor of Philosophy / The United States and South Africa, exemplars of "archsegregation," have been constituted within an arc of historical racialized delineations which began with the centering, and subsequent overrepresentation, of European maleness and whiteness as the sole definition of Man. Globally present and persistent, these racialized delineations have been localized and spatially embedded through the tools of urban planning. This arc of racialized otherness, ineffectively erased, continues to inform the racially differentiated geospatial, health, social, and economic outcomes in contemporary urban form and functions for Black communities. It is within this historical arc, and against these differentiated outcomes, that contemporary urban discourse and contestation between individuals and institutions are situated. This historical othering provides not just a racialized geo-historical contextualization, but also works to preclude the recognition of the some of the most vulnerable urban community members. As urbanists and advocates strive to co-create urban space and place with municipalities, meeting the needs of these residents is imperative. In order to meet these needs, their lived experiences, and voices must be fully recognized and engaged in the processes and programs of urban co-creation, including in digital spaces and forums. Critical to achieving recognition acknowledging and situating contemporary digital discourses between local municipalities, Black residents, and Black networks within this historically racialized arc is necessary. In doing so, explore if, and how, race, specifically Blackness, is enacted in municipal digital discourse, whether these enactments serve to advance or impede resident recognition and participation, and how Black users, as residents and social network curators, engage and respond to these municipal discursive enactments. This exploratory research is a geographically and digitally multi-sited incorporated comparison of Chicago, Illinois, and Johannesburg South Africa. Using Twitter and ethnographic data collected between December 1, 2019, and March 31, 2020, this research layers digital ethnographic mixed methods and qualitive mixed methods, including traditional ethnographic, digital ethnographic, grounded theory, social change and discourse analysis, and frame analysis to explore three research goals. First, explore the digital discursive practices and frames employed by municipalities to inform, communicate with, and engage Black communities, and, if and how, these frames are situated within a historically racialized arc. Second, identify the ways in which Black residents, in dual discursive engagements with local municipalities and their own social networks, interact and engage with the municipal frames centering on Blackness. Third, through ethnographic narratives, acknowledge the marginalized residents of the Central Business District of Johannesburg, South Africa as "agents of knowledge," with critical and valuable knowledge claims which arise from their lived experiences anchored within racialized place and space. In doing so, support the efforts of these residents in recentering the validity of their knowledge claims in the co-creation of urban place and space. Additionally, in situating the city within a historically racialized arc develop novel frameworks, the racialized palimpsest city and syndemic segregation, through which to explore contemporary urban interactions and engagements.

2025 / This dissertation examines the role of the 340B Drug Pricing Program in the US health care safety-net and its implications for access, affordability, and health equity. The 340B Program allows certain hospitals and public health clinics that serve a disproportionate share of low-income patients to purchase outpatient drugs from manufacturers at steep (estimated 25–75%) discounts; however, the 340B statute does not specify whether discounts are to be passed along to patients nor how profits generated from full price drug sales of discount-acquired drugs (i.e., “spread pricing”) is to be spent. This has led to calls for reform. At the same time, the 340B Program is well-situated to play an important role in the delivery of care for syndemic conditions (i.e., HIV, substance use disorder (SUD), mental health disorders), which disproportionately affect marginalized patient populations.Revenues generated from the 340B program present a key opportunity for hospitals to invest in low-profit services that may especially benefit socially and economically marginalized patient populations, such as HIV and SUD services (i.e., “mission motivated” behavior). However, providers face competing financial incentives to reinvest 340B revenue into high-profit services or services with high-cost drugs to maximize spread pricing (i.e., “margin motivated” behavior). The impact of the 340B program on low-profit or syndemic service provision is unclear. The overarching goal of this dissertation is to assess the relevance of the 340B Program to hospital finances, safety-net spending, and provision of low-profit services. This dissertation has three aims. First, I synthesize what is known about the 340B Program in the peer-reviewed, empirical literature via a systematic scoping review, categorizing outcomes indicating margin- versus mission-motivated behavior by 340B providers. Second, I assess the financial wellbeing and service provision decisions of nonprofit hospitals in the years following enrollment into the 340B Program using a staggered difference-in-differences design, based on 20 years (2000–2019) of Medicare Cost Reports and American Hospital Association survey data. Third, I estimate the impact of a 340B Medicare reimbursement cut on nonprofit hospital finances and safety-net spending outcomes, using a triple differences approach, based on cost reports and hospital tax filings. / 2027-01-16T00:00:00Z