Structural Competency as a Global Framework for Syndemic HIV Care: A Critical Synthesis

The co-occurrence of HIV with mental health disorders, substance use, and tuberculosis continues to constitute significant global public health issues. Syndemic theory elucidates how these conditions interact synergistically to exacerbate health outcomes, reduce engagement in care, and hinder adherence to antiretroviral therapy. Structural competency offers a useful framework for conceptualizing and addressing the broader social, economic, and political determinants that influence health outcomes for people living with HIV as well as mental illness, substance use issues, and tuberculosis. We call for a shift toward structural competency, encouraging health care providers to move beyond individual-level interventions and address the root causes of health inequities through holistic, multilevel approaches that improve outcomes for those affected by HIV and its intersecting syndemics.