In Response to the Published Article “A Syndemic Model of Substance Abuse, Intimate Partner Violence, HIV Infection, and Mental Health among Hispanics”

Dear Editor, As a doctoral nursing student interested in reducing health disparities among vulnerable populations, I applaud Gonzalez-Guarda and colleagues efforts in developing the Syndemic Model of Substance Abuse, Intimate Partner Violence, HIV Infection, and Mental Health among Hispanics. The article included a thorough review of current literature and an elegant syndemic model with detailed explanations. However, I would like to point out an error missed by the authors and an area of potential confusion in the article. Gonzalez-Guarda and colleagues referred to a study by Abel and Chambers (2004) and pointed out that “Abel and Chambers found that less acculturated women were more comfortable using condoms” (Gonzalez-Guarda, Florom-Smith & Thomas, 2011; p. 372). In reviewing the original article written by Abel and Chambers, I could not find such information in the article. Under the conceptual framework section of Abel and Chambers’s article, they referred to a study by Ford and Norris (1993; as cited in Abel and Chambers), and stated, “More highly acculturated Hispanic women also were more likely... to use condoms than women with lower acculturation levels” (p. 758). In the discussion section, Abel and Chambers explained their study results of “the relationship among motivation for...condom use may be explained in part by lower acculturation and consequent stronger influences of simpatia, familialism, collectivism, and fatalism” (Marin, 1999; Marin & Marin, 1991; as cited in Abel and Chambers). Thus, Gonzalez-Guarda and colleagues’ notion of acculturation being protective for some groups of Hispanics does not hold. Besides the error mentioned above, GonzalezGuarda and colleagues propose the Syndemic Model consisting of four groups of protective or risk factors associated with the syndemic conditions. The authors had culture as a separate level of influence to underline the importance. Although culture is an essential aspect to take into consideration, listing culture as a separate factor created some confusion in the categorization. For instance, “Hispanic stress” listed under cultural factors “is the strain associated with conditions common to Hispanics in the United States, such as the acculturation process...and perceived or actual discrimination and racism,” while acculturation itself is listed as an individual factor under cultural factors, and discrimination is listed under socio-environmental factors. Although the authors mentioned