Auerbach et al. [1] developed a
model to assess social and structural drivers of HIV to
inform intervention development. Poundstone et al. [9]
presented a heuristic framework of the social epidemiology
of HIV that highlights the social and structural determinants
of the epidemic. Other models have examined ecological-level risk factors for HIV such as
structural violence [11,12] and social factors such as
stigma and discrimination [4].
We build on past frameworks by a) examining multilevel
risks and risk contexts for HIV infection and b)
situating individual risks in the network, community,
and public policy contexts as well as the epidemic stage.
We developed the modified social ecological model
(MSEM) to help visualize multi-level domains of HIV
infection risks and guide the development of epidemiologic
studies of HIV. We argue that data on risk factors
and these multiple levels should be collected routinely
as part of any epidemiologic study.