Table 3.

Behavioral synergisms

Behavioral Factor	Impact on ID	Impact on other synergistic factors	Potential Interventions
Substance use	Injection drug use is a pathway of HIV and HCV transmission Increases STI and HBV risk behavior. Interferes with medication adherence	Increases psychiatric comorbidity Associated with increased experiences of violence	Community needle and syringe programs MOUD SBIRT screening Contingency management Relapse prevention, Cognitive behavior therapy
Psychiatric comorbidity	Increases HIV, HCV, HBV, and STI risk behavior Interferes with ART and other medication adherence	Increases substance use	Depression screening among gay and bisexual men Tailored cognitive behavioral therapy like ESTEEM for gay/bi men
Violence	Increases HIV, HCV, HBV, and STI risk behavior	Increases psychiatric comorbidity and substance use Intimate partner violence increases risk of homelessness	CBT-based interventions that tailored to victims of violence(133, 134) Web-based and remote interventions for victims of IPV(135) Economic strengthening interventions for victims combined with and gender transformative interventions for perpetrators(136) Housing interventions for victims of IPV(137)