In this Series paper, we review evidence on the co-occurring and synergistic epidemics (syndemic) of HIV and mental health problems worldwide among men who have sex with men (MSM). The multilevel determinants of this global syndemic include structural factors that enable stigma, systematic bias, and violence towards MSM across geographical and cultural contexts. Cumulative exposure to these factors over time results in population-level inequities in the burden of HIV infections and mental health problems among MSM. Evidence for this syndemic among MSM is strongest in the USA, Canada, western Europe, and parts of Asia and Latin America, with emerging evidence from sub-Saharan Africa. Integrated interventions are needed to address syndemics of HIV and mental health problems that challenge the wellbeing of MSM populations worldwide, and such interventions should consider various mental health conditions (eg, depression, anxiety, trauma, and suicidality) and their unique expressions and relationships with HIV outcomes depending on cultural contexts. In addition, interventions should identify and intervene with locally relevant structural factors that result in HIV and mental health vulnerabilities among MSM.

在本系列文章中，我们回顾了全球范围内男男性行为者 (MSM) 中 HIV 和精神健康问题的同时发生和协同流行病的证据。这种全球性流行病的多层次决定因素包括结构性因素，这些因素导致跨越地理和文化背景的污名化、系统性偏见和对 MSM 的暴力行为。随着时间的推移，这些因素的累积暴露导致 MSM 中 HIV 感染负担和心理健康问题在人群层面的不平等。在美国、加拿大、西欧以及亚洲和拉丁美洲的部分地区，男男性接触者之间这种流行病的证据最强，撒哈拉以南非洲的证据也越来越多。需要采取综合干预措施来解决挑战全球 MSM 人群福祉的 HIV 综合症和精神健康问题，此类干预措施应根据文化背景考虑各种心理健康状况（例如，抑郁、焦虑、创伤和自杀倾向）及其独特的表现形式和与 HIV 结果的关系。此外，干预措施应确定并干预导致 MSM 中 HIV 和心理健康脆弱性的当地相关结构性因素。