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An important insight about health ushered in by the emergence of HIV/AIDS and its rapid spread across the planet is that the standard medical way of looking at disease is a distortion. Although medicine claims to be culture free its conception of the nature of the world and of basic life processes is rooted in a particular construction of reality that reflects Western culture. In medicine, as well as in public health, the traditional strategy has been to narrowly focus attention on individual diseases. This orientation, derived from the Western philosophical practice known as reductionism, has been dominant since the rise of germ theory in the mid-1800s. Reductionism asserts that complex phenomena are best understood as a set of separable parts independent of other parts and of their natural context. Reflective of this atomistic approach to knowledge, medicine separates the patient from his/her social network and community, diseased organ systems from the whole body, a disease from other co-morbid conditions, each disease into its constituent parts, and the treatment of disease through assignment to narrowly focused medical specialties.
HIV/AIDS, however, has proven to be such a challenge, in part, because it tends to be found in close alignment with a host of other diseases, infectious and chronic. As a result, research on the multiple diseases of people living with HIV/AIDS has helped to foster a new conception of disease itself. This new perspective, known as syndemics theory, moves conception of health beyond the narrow frames of customary reference. An essential feature of syndemics can be grasped through a glimpse at an unexpected life form, the lichen. While in appearance and structure the often taken-for-granted lichen appears to be a simple plant; but in fact it constitutes a symbiotic community that intertwines a fungus, most commonly a member of the family that includes truffles and Baker's yeast, with an algae, usually green or blue-green algae. As an interactive group of species, lichen represent a living pathway between organisms and ecosystems. They are at once composed of identifiable species and of interactive processes and relationships. Reducing them to individual categories, however, reduces as well our ability to understand their essential interactive nature.
Syndemics theory brings this same understanding to the study of health. A syndemic is defined as a set of enmeshed and mutually enhancing health problems that, working together in a context of adverse social and physical conditions, can significantly affect the overall disease burden and health status of a population. From the syndemics perspective, since many of the primary contemporary threats to the health, from cancer to heart disease and from diabetes to HIV/AIDS, often are found together rather than as independent epidemics they really are not completely separable phenomena.
A syndemics approach, consequently, examines both "disease concentrations" (i.e., multiple coterminous diseases and disorders affecting individuals and groups) and "disease interactions" (i.e., the ways in which the presence of one disease enhances the health consequences of other co-present diseases, such as paving the way for new infection as HIV/AIDS does with a host of opportunistic diseases but with non-opportunistic diseases like kidney disease, cancer, and malnutrition as well). Of concern to the syndemics approach, as a result, is the nature of the specific biological and social pathways through which diseases and other health conditions interact in individual bodies and in populations.
Consequently, at its simplest level, the term syndemic labels two or more epidemics interacting synergistically and contributing, as a result of this interaction to excess disease. Importantly, the term syndemic refers not only to the co-occurrence of two or more diseases, but also to the identifiable health consequences of biological interactions among co-present diseases. In a syndemic, interaction between diseases commonly occurs because adverse social conditions (e.g., poverty, stigmatization, and discrimination) puts a group at heightened risk for multiple health problems. It is this kind of interaction, for example, that explains both the intense HIV/AIDS epidemic in Southern Africa as well as the disproportionate rate of HIV/AIDS among African Americans and Latinos in the United States.
For more information see http://www.cdc.gov/syndemics/overview.htm and http://en.wikipedia.org/wiki/Syndemic
