Social and behavioural determinants of health: studies on HIV, sexually transmitted infections, and mental health

• Autores: Ana María Méndez López
• Directores de la Tesis: Jeffrey V. Lazarus (dir. tes.)
• Lectura: En la Universidad Autónoma de Madrid ( España ) en 2024
• Idioma: inglés
• Número de páginas: 137
• Títulos paralelos:
  • Determinantes sociales y conductuales de la salud: estudios sobre el VIH, infecciones de transmisión sexual y salud mental
• Enlaces
  • Tesis en acceso abierto en: Biblos-e Archivo
• Resumen

  • The health and well-being of individuals and communities are profoundly determined by a complex interplay of the contexts and conditions in which they live. These factors, known as social and structural determinants of health, encompass non-medical aspects that impact health outcomes. They include the conditions in which people are born, grow, work, live, and age, as well as the broader forces and systems shaping their daily lives. Additionally, individual lifestyle choices and behaviours can either promote or put health at risk, referred to as behavioural determinants, which are influenced by both individual factors, such as genetics and personality, and social and structural determinants. Variations in social and structural conditions among individuals and communities can result in significant disparities in health outcomes. By addressing these determinants, we can foster health equity and create conditions that enable all individuals to lead healthy and fulfilling lives. This dissertation investigates social, structural, and behavioural determinants of health through five studies focused on HIV, sexually transmitted infections (STIs), and mental health during the COVID-19 pandemic. These five studies provide quantitative evidence for the role of different social and behavioural aspects in determining public health and epidemiological outcomes in these disease areas. The studies report factors at the micro- and macro-levels that contribute to health inequalities, identifying potential intervention areas to improve health outcomes and promote health equity. The first study examines social and behavioural determinants of syphilis among men who have sex with men (MSM) across 31 countries in Europe. This study highlights the contribution of social and behavioural factors to rising syphilis diagnoses in Europe, such as STI screening practices the number of non-steady male condomless anal intercourse partners, engagement in sex work, and the use of pre-exposure prophylaxis. The study identifies strengthened regular screening as a potential key interventional area for syphilis control and its implementation feasibility in HV pre-exposure prophylaxis (PrEP) clinical guidelines. The second study offers methodological insights into a crucial behavioural determinant of STIs and HIV transmission rates: the number of sexual partners. The study offers insights into designing sexual behaviour surveys that accurately measure the number of sexual partners among MSM and understand biases associated with alternative approaches. The results provide, first, an empirical basis for converting banded ordinal data on numbers of sex partners into a continuous scale-level variable. Second, it provides evidence on the distribution and clustering of responses about the number of sexual partners, showing that some individuals report a high number of partners above common cut-off values used in surveys. The third study investigates HIV-related stigma and discrimination, its sociodemographic determinants and its impact on HIV testing uptake in 64 low- and middle-income countries. The results reveal the wide prevalence of stigma, albeit with varying degrees across countries. Results show a social gradient in holding stigmatizing attitudes, as well as an association between stigma and lower HIV testing uptake, highlighting the need for targeted interventions to eliminate stigma for improving the quality of life of people with HIV and as a means of HIV elimination. The fourth study assesses the impact of national HIV treatment guidelines as a structural determinant of HIV outcomes in 37 countries in Europe and Central Asia. The study demonstrates the population-level benefits of implementing ‘test-and-treat’ antiretroviral therapy (ART) guidelines, which recommend initiation of ART upon diagnosis regardless of CD4 cell count, which improve ART access and viral suppression and reduce HIV transmission, further strengthening evidence that rapid initiation of treatment helps curb the spread of HIV. Finally, the fifth study investigates the role of national social protection systems and pandemic-specific measures on mental health well-being during the COVID-19 pandemic in 26 European countries. The study reveals that the COVID-19 pandemic has led to substantial mental health deterioration in older adults, particularly among socioeconomically disadvantaged individuals. Physical distancing measures exacerbated this decline, while stronger social protection decreased the risk of mental health worsening, emphasizing the importance of robust social support systems for mental health, particularly during crises. Overall, the findings from these studies underscore the importance of addressing the social, structural, and behavioural determinants of health and implementing evidence-based comprehensive disease prevention and health promotion interventions to improve health and well-being