What is a Syndemic Anyways?

The term syndemic comes from two more commonly used words: synergy and epidemic. Synergy refers to an interaction or cooperation that gives rise to a whole greater than the simple sum of its parts. An epidemic is the widespread occurrence of health condition in a community at a particular time. With these meanings combined, a syndemic is two or more epidemics that are connected through behavior, biology, and social factors that results in a enhanced health burden across a population.

How is Tennessee Defining this syndemic?

To be considered a syndemic three criteria need to be met: (1) Data has to demonstrate separate epidemics are actually occurring; (2) The included health conditions interact through behavior or biology to increase overall health burden; and (3)There must be common social factors contribute to and sustain the epidemics. Using this criteria the health conditions included int End the Syndemic Tennessee are: HIV, sexually transmitted infections (STI), substance use disorder (SUD), and viral hepatitis (VH)

HIV

Human Immunodeficiency Virus

19,523 People

during 2021 were living with diagnosed HIV in Tennessee

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STIs

Sexually Transmitted Infections

400% Increase

in reported congenital syphilis instances from 2019 to 2020 in Tennessee

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SUD

Substance Use Disorder

3,826 People

died of a drug overdose in Tennessee during 2021

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VH

Viral Hepatitis A, B, & C

8th Highest

rate of hepatitis C in the nation in 2021

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Why Taking a Syndemic Approach Makes Sense in Tennessee

After the HIV and hepatitis C outbreak associated with injection drug use in Scott County, Indiana, the CDC conducted a national analysis to understand what other counties in the United States were vulnerable to this sort of incident. Their assessment identified 220 counties in the U.S. that were most vulnerable, and 41 of those 220 counties are in Tennessee.

When TDH conducted their own vulnerability assessment using more recent data and local indicators they found even more widespread vulnerability. Every single county in Tennessee was vulnerable to this sort of outbreak to some degree. You can learn more about Tennessee assessment by clicking the button to the left.

The vulnerability assessment among epidemiology trends in the state, made it clear that the HIV, sexually transmitted infection, substance use disorder, and viral hepatitis epidemics were intertwined, pushing TDH to take a new approach to strategic planning. This is when the idea of End the Syndemic Tennessee began to really take form. You can explore how we approached this strategic planning process below.

How Tennessee Approached Syndemic Planning

Established Internal Syndemic Workgroup

Program directors and key epidemiologists across the Tennessee Department of Health (TDH) and the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) began to meet regularly to discuss collaboration and a statewide community engagement strategy.

Recruitment to Regional Planning Groups

Recruitment to End the Syndemic Tennessee (ETS) regional planning groups began. Through focused recruitment efforts and regional syndemic champions, 407 people across the state registered to join ETS. This included service providers, service consumers, people with living/lived experience, academics, private industry, and more!

Regional Planning Meetings Begin

Each of the 7 ETS regional planning groups began to virtually meet monthly. Early planning meetings focused on goal and guiding principle development. Then data and evidence-based interventions were presented and facilitated discussion took place to identify priorities, barriers, and strategies of interest to meet the ETS goals.

Launched the ETS Networking Platform

Regional planning meetings naturally sparked connections and planning members requested to grow these connections between monthly meetings. The End the Syndemic Tennessee Virtual Networking Platform was then launched. This fully interactive space allows individual and group chats, announcements, events, and resources to be shared with ease.

Assessed Planning Group Membership

Midway through the regional planning meeting process, a demographic survey was launched to take stock of who was still engaged to ensure priority populations and people with lived/living experience were well represented. Data from this survey was used to increase focused recruitment efforts and identify priority groups for focus groups and in-depth interviews.

Launched the Syndemic Needs Assessment Survey

The End the Syndemic Tennessee Needs Assessment survey was developed to better understand needs, gaps, barriers, and facilitators related to HIV, STIs, substance use disorder, and viral hepatitis prevention and care services from consumer and provider perspectives. In-person and phone surveying was offered to reach those without internet capabilties.

Regional Planning Meetings Conclude

Towards the end of the regional planning meetings, emerging strategies were presented back to the planning groups for additional feedback. Over the course of 2 years, 80 regional planning meetings were held across all ETS regions. Notably, ETS was the most extensive community-informed planning process to address the HIV, STI, substance use disorder, and viral hepatitis syndemic.

Syndemic Needs Assessment Focus Groups & Interviews

To glean more nuanced insights from ETS priority populations that were underrepresented in the ETS regional planning groups, focus groups and in-depth interviews were conducted in collaboration partnerships across the state. Prioritized groups were identified through data from the demographic survey conducted midway through the ETS planning process.

Drafting the End the Syndemic Tennessee Plan Begins

Information learned from regional planning groups, the needs assessment survey, focus groups, in-depth interviews, internal workgroup meetings, local Ending the HIV Epidemic Plans, previous integrated HIV plans, federal plans, and federal planning guidance all informed the drafting of the End the Syndemic Tennessee Strategic Plan.

December 2019

March 2020

October 2020

April 2021

April 2022

June 2022

October 2022

November 2022

What End the Syndemic Tennessee Aims to Achieve

Guiding Principles: Health Equity Health Autonomy Status-Neutral Care Evidence-Based Programs

Health Justice

Health justice addresses short-term differences in need (health equity) while also working towards long-term sustainable and equal access to health and wellness resources, which requires addressing social and structural barriers to health.

Status-Neutral Care

Status Neutrality, is a whole person approach characterized by delivering high-quality and comprehensive services regardless of whether a person diagnosed with a condition or not. Treatment is prevention. Prevention is treatment.

Evidence-Based Programs

Evidence-based approaches incorporate quantitative (numbers) and qualitative (words/feelings) data into decision making. This is supported by quality data collection that is shared with community in accessible and acceptable ways.

Health Autonomy

Health autonomy is the principle that people have the right to make informed decisions about their own body, health, and wellbeing including the choice to engage or not engage in services. Health autonomy centers empowerment over control.

What People Said About End The Syndemic Tennessee Planning

“I FINALLY have a voice…it’s been wonderful with many difference aspects covered from many different voices"

“been wonderful working for an org that is based in one city but operates statewide because opportunity to meet professionals and community members throughout the state… allows interaction that allows us to get to know others and form partnerships…”

"It is great to be able to hear from professionals and people with lived experience and take what they have shared to make sure we are meeting needs of our community the best that we can