Examining the association between behavioral health syndemics and menopausal symptoms in women living with and without HIV - Menopause is a period experienced by women between the ages of 45-60. As the population of women with HIV (WWH) ages, it's crucial to understand the relationship between HIV and menopause. Compared to women without HIV (WWOH), WWH often experience higher rates of behavioral health issues, including substance use and mental health distress, which may affect menopause onset and symptoms. Hormone replacement therapy (HRT) is a common treatment for menopause, but research on the interaction with mental health effects is mixed. Some studies report a reduction in mental health disorders, such as depression, with HRT use, while others indicate an increased risk of depression. HRT is a behavioral intervention, requiring initiation and adherence, yet little research has explored how behavioral health (i.e., substance use, mental health, and HRT) influences menopausal symptoms in both WWH and WWOH. Using syndemic theory, this study aims to identify syndemic phenotypes of behavioral health issues and HRT use in WWH and WWOH aged 35-70, from premenopause to perimenopause, using latent class analysis. We will examine how these behavioral health syndemics relate to common perimenopausal symptoms, stratified by HRT use and HIV status. To achieve the goals of this study, we will utilize the Women’s Interagency HIV Study (WIHS, N= 4,000) to analyze syndemic changes and symptom profiles. Additionally, we will conduct qualitative interviews with WWH who are experiencing menopause to understand the impact of behavioral health syndemics during this hormonal shift in real time (N=25). This Kirschstein NRSA Predoctoral Fellowship (PA-23-272) proposal seeks to conduct a multiphase sequential explanatory mixed-methods study to understand psychosocial changes during menopause, the role of HIV, and the syndemic impact on symptoms. This proposal responds to the NIH Office of Research on Women's Health (ORWH) Notice of Special Interest (NOT-OD-24-079) and the National Institutes of Aging (NIA) interest in psychosocial changes during and associated with menopause . A benefit of this award is training to establish the foundation of a successful career in epidemiologic research and intervention science such as 1) learning strengths, limitations, and implications of using longitudinal public health data to measure substance use and health outcomes; (2) understand the rationale for using different statistical methods to answer longitudinal research questions with public health data; and (3) leading collection and analysis of qualitative data as part of a mixed-methods study, in addition to developing skills such as manuscript production and giving presentations.
