Stigma Syndemics and End-Stage Kidney Disease in Disenfranchised Urban Communities Fighting Covid-19

Although Covid-19 is impacting all communities, the distribution of its harms is not equal. Poor, urban people of color with compromised health are particularly hard-hit. Combining remote ethnographic and epidemiological research methods, we will explore how residents of underprivileged urban communities who suffer from end-stage kidney disease (ESKD) and associated stigmas manage their illness and treatment experiences in the face of Covid-19. Using the lens of syndemics research to conceptualize stigma as a social determinant of health that leads to negative outcomes by intensifying sufferers' sense of isolation and alienation and thereby magnifying the biosocial harms caused by diseases, we hypothesize that Covid-19 adversely interacts with ESKD patients' poor health and social status. Beyond biosocial health, this study is designed to gain a deeper understanding of patients' spiritual and political challenges and sources of support. Collected interview and survey findings will inform policymakers and medical caregivers seeking to alleviate the inequitable conditions suffered by marginalized, chronically ill patients and their family or other caregivers in Greater Boston and beyond, in cities such as New York, Chicago, and Philadelphia.