Eleven qualitative studies examined shame, substance use, and interpersonal violence as syndemic factors (Payne et al., 2014, Sanders, 2011, Sun et al., 2016, Choo et al., 2015, Curtis et al., 2021, Daniulaityte and Carlson, 2011, Grieb et al., 2019, Hequembourg et al., 2021, MacLean et al., 2017; Thompson et al., 2022; Warf et al., 2013). Two qualitative studies focused on sex workers (Warf et al., 2013, Grieb et al., 2019), describing elevated levels of shame, substance use (e.g., alcohol