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

Black communities in the US are experiencing three converging public health crises: COVID-19, systemic racism, and community and police violence. Black Americans are significantly less likely to receive a needed COVID-19 test and have higher rates of COVID-19 infection and death than white Americans. Additionally, Black communities have experienced a surge in gun violence in 2020 and continue to be victims of police harassment and violence, resulting in large-scale social justice demonstrations. The convergence of these epidemics has created a syndemic, wherein racism, violence, and COVID-19 cluster in predominantly Black and low-income communities. This study aimed to characterize this syndemic to understand how personal and systemic racism and violence in Black communities may influence COVID-19 testing decisions. This mixed-method study with Black residents of Chicago, IL resulted in community-driven recommendations to enhance COVID-19 testing and prevention strategies and address this emerging syndemic. The potential mediating pathways of medical mistrust, psychological trauma and stress, and economic injustice were examined in this study. Additionally, a strengths-based approach was taken to understand potential protective factors including neighborhood cohesion, social support, and access to health care. The specific aims of the study were to: 1) Qualitatively examine how experiences of racial discrimination, community violence, and police violence influence trust in, and engagement with, healthcare systems and contribute to decisions around COVID-19 testing and mitigation strategies (e.g., social distancing) among Black individuals in Chicago (N=S0); 2) Quantitatively assess the prevalence and correlates of COVID-19 testing among Black residents in Chicago (N = 500) and characterize the COVID-19, racism, and violence syndemic; and 3) In partnership with a Community Advisory Council, use an integrative translational workshop approach and intervention mapping techniques to develop community and data-driven recommendations and an intervention blueprint for local health departments, researchers, and public health organizations to improve COVID-19 testing among Black Americans. This study resulted in policy and research recommendations, community resources, and a 'shovel-ready' intervention blueprint to enhance COVID-19 testing and address this emerging syndemic.