Substance Use, Violence, and HIV Risk Behavior in El Salvador and the United States: Cross-National Profiles of the SAVA Syndemic

Abstract: Studies examining the SAVA Syndemic—that is, the synergistic links between substance use, violence, and HIV risk behavior—have rarely been conducted cross-nationally. Using samples of high-risk youth in San Salvador, El Salvador (n = 237) and western Pennsylvania, United States (n = 253), latent class analysis is employed to identify behavioral subgroups of youth. Subgroups of “SAVA Youth” characterized by universally elevated levels of substance use, violence, and HIV risk behavior were identified in both El Salvador (20%) and the United States (42%). Membership in these behaviorally severe subgroups was associated with extremely high levels of severe violence exposure.