A multilevel framework of HIV/AIDS and STI risk

Understanding the disparities in HIV/AIDS in minority populations, especially African American women, is critical to improving the nation's health. African American women are at a greater risk of contracting HIV and other STIs than any other ethnic group of women in the U.S. To date the research on HIV/AIDS risk has been dominated by individual-level models of behavior change. Although these data have been useful in designing individual-level interventions, these interventions have had limited impact in reducing the spread of HIV/AIDS. Relatively few studies have utilized multilevel models to explain heterosexual transmission of HIV/AIDS looking beyond the individual-level into the social structure in which women and men are negotiating sexual encounters. Study of sexual networks is a notable example. A multilevel framework of HIV/AIDS sexual risk behaviors is needed to develop a fuller picture of the context in which the sexual transmission of HIV/AIDS occurs. Such a framework would include not only socio-demographic conditions (i.e., variables that measure the social and demographic characteristics of communities), but the structural environment as well (e.g., the built environment), and their influence upon characteristics of women at risk, their heterosexual partners, and their sexual relationships. Studies using such a framework could address interventions through public policy and urban planning, as well as individual-level interventions. The authors will present such a framework and apply it to African American women at risk for HIV/STIs.