Modified social ecological model: A tool to guide the assessment of the risks and risk contexts of HIV epidemics

BMC Public Health (Impact Factor: 2.26). 05/2013; 13(1):482. DOI: 10.1186/1471-2458-13-482
Source: PubMed


Social and structural factors are now well accepted as determinants of HIV vulnerabilities. These factors are representative of social, economic, organizational and political inequities. Associated with an improved understanding of multiple levels of HIV risk has been the recognition of the need to implement multi-level HIV prevention strategies. Prevention sciences research and programming aiming to decrease HIV incidence requires epidemiologic studies to collect data on multiple levels of risk to inform combination HIV prevention packages.

Proximal individual-level risks, such as sharing injection devices and unprotected penile-vaginal or penile-anal sex, are necessary in mediating HIV acquisition and transmission. However, higher order social and structural-level risks can facilitate or reduce HIV transmission on population levels. Data characterizing these risks is often far more actionable than characterizing individual-level risks. We propose a modified social ecological model (MSEM) to help visualize multi-level domains of HIV infection risks and guide the development of epidemiologic HIV studies. Such a model may inform research in epidemiology and prevention sciences, particularly for key populations including men who have sex with men (MSM), people who inject drugs (PID), and sex workers. The MSEM builds on existing frameworks by examining multi-level risk contexts for HIV infection and situating individual HIV infection risks within wider network, community, and public policy contexts as well as epidemic stage. The utility of the MSEM is demonstrated with case studies of HIV risk among PID and MSM.

The MSEM is a flexible model for guiding epidemiologic studies among key populations at risk for HIV in diverse sociocultural contexts. Successful HIV prevention strategies for key populations require effective integration of evidence-based biomedical, behavioral, and structural interventions. While the focus of epidemiologic studies has traditionally been on describing individual-level risk factors, the future necessitates comprehensive epidemiologic data characterizing multiple levels of HIV risk.

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Available from: Andrea L Wirtz, Apr 29, 2014
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    • "The survey included modules characterizing multiple levels of HIV risk as explained in the Modified Social Ecological Model (MSEM), which characterizes the various levels of HIV risk among key populations. These levels include the individual, network, community, public policy, and prevalence or incidence of HIV in country (or epidemic stage) (Baral et al., 2013). "
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    Full-text · Article · Aug 2015 · PeerJ
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    • "The strength or weakness of the economy of a region also plays an important role in determining the health of the community, due to factors such as employment and standard of living. At the community level, social norms may promote health behaviors or worsen them through stigma and other cultural or religious beliefs (Baral et al., 2013; Poundstone et al., 2004). Therefore, consideration of the totality of the risk environment is tantamount to understanding what drives the HIV epidemic in each diverse region. "
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