Understanding the COVID-19, Racism, and Violence Syndemic and Its Effects on COVID-19 Testing Disparities

Background: Black communities in the United States faced overlapping crises during the COVID-19 pandemic. These included high infection and death rates, systemic racism, and rising community and police violence. Together, these issues created a syndemic that placed Black residents at greater risk and discouraged timely COVID-19 testing. Many Black Americans were less likely to receive needed testing because of medical mistrust, exposure to discrimination, psychological stress, and economic hardship. At the same time, community strengths such as neighborhood cohesion, social support, and access to trusted health resources shaped how people made decisions about testing and prevention. The purpose of this study was to understand how these combined forces influenced testing decisions among Black residents in Chicago.

Materials/Methods: The study used a mixed-method design. First, qualitative interviews with Black residents explored personal experiences with racial discrimination, community violence, and police violence, and how these experiences shaped trust in healthcare systems and decisions about testing and risk reduction behaviors. Second, a quantitative survey of Black residents measured the prevalence and correlates of COVID-19 testing and characterized how racism, violence, and COVID-19 interacted as a syndemic. A Community Advisory Council guided the study design, interpretation of findings, and development of recommendations. The team used an integrative translational workshop model and intervention mapping techniques to produce actionable guidance for health departments and public health partners.

Outcome/Impact: The study clarified how racism, violence, and COVID-19 combined to influence testing behaviors among Black residents in Chicago and highlighted important barriers and strengths within these communities. Findings showed how discrimination, trauma, and structural inequities reduced engagement with testing. The findings also identified community-level supports that encouraged health-seeking behavior. This work produced policy recommendations, community resources, and a detailed intervention blueprint that local health departments, researchers, and public health organizations could use to improve testing access in Black communities. The results offered a clear pathway for developing interventions that address the syndemic and strengthen trust in public health systems.