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Background: In the extremely homophobic conditions in Tanzania and other countries in sub-Saharan Africa (SSA), men who have sex with men (MSM) experience disproportionate amounts of both HIV infection and psychosocial health problems, but no research has been conducted to examine the synergistic or additive effects of these adversities on their experiences. While the predominantly deficit-based research approach has identified various HIV risks and vulnerabilities, any naturally occurring protective and resilience factors that these men naturally employ to these health-related adversities remain undetermined. Purpose: This study examined the syndemic effects of psychosocial health problems on HIV infection and HIV risk and simultaneously sought to identify any resilience or protective factors that may buffer against the syndemic production of HIV infection and risk behavior among high-risk Tanzanian MSM. These syndemic health problems were coined as SAVID (Substance abuse during condomless sex, childhood and adolescent sexual abuse, violence, internalized homonegativity and depression) Methods: Cross-sectional data on demographic characteristics and HIV prevalence and risks among Tanzanian MSM residing in Dar es Salaam and Tanga were used to examine whether there is a proportional increase in HIV infection and risk as the number of syndemic conditions increases. Logistic regression analysis was used to test for interactions between syndemic conditions and to identify any potential resilience factors as a way of establishing protection against the syndemic production of HIV infection and risk among these men. At the level of interaction between protective resilience factors (moderators)-support, age visibility- and SAVID syndemic; those that reported high social visibility among Acquaintance have lower odds of contracting HIV infection when compared to those that have lower social visibility among acquaintances Results: The results revealed significant additive associations between increasing numbers of SAVID syndemic components and higher rates of HIV infection and risk. Among a variety of identified potential resilience factors, three-functional socio-support, age at self-awareness of sexual orientation and formal social visibility among acquaintances-were found to directly associated with lower odds of contracting HIV infection. At the level of interaction between protective resilience factors (moderators: functional social support, age at awareness of sexual orientation, and formal social visibility among acquaintances) and SAVID syndemics, only those sampled MSM that reported high social visibility among acquaintances had lower odds of contracting HIV infection when compared to sampled MSM that had lower formal social visibility among acquaintances Conclusion: Harnessing naturally-occurring resilience factors through strength-based research approach and innovatively disseminate them through existing secrete social network may be a cost effective and a novel health promotion strategy suitable for MSM in extreme homophobic environment.

Resilience Factors as a Buffer against the Effects of Syndemic Conditions on HIV Risk and Infection among Tanzanian MSM