Allow over-the-counter sales of sterile syringes without a prescription or allocation of millions of dollars for ART treatment or social mobilization efforts like Thailand’s 100 condom campaign),37-40 and national decisions to allow and finance harm reduction efforts (e.g. opiate replacement treatment programs like Flavopiridol solubility methadone or suboxone) for injection opiate users. “Meso evel” structural factors refer to systems within the more immediate institutions in which individuals or groups are involved and the contexts of those institutions.36 These factors link macro elements with elements that influence health from more proximal levels. Meso-level influences can include neighborhood context (e.g., deteriorated housing or transportation systems), community organizations such as facilities that provide access to health care, and features of the environment that may facilitate and impede risk such as the presence of bathhouses or “shooting galleries” in an area. Meso-level factors also include broad social networks (sometimes referred to as macro-networks) of particular groups, ranging from drug users or men who have sex with men (MSM) to organized community action groups, electronic networks of “friends,” and the social capital that comes with these networks. Structural interventions designed to address meso-level influences on HIV risk and susceptibility include network diffusion models,41-44 at-risk community mobilization efforts,45-47 and development of housing for chronically homeless drug users and others at risk for or infected with HIV.48 The term “micro” level, when used to describe structural factors, often refers to the immediate social and physical context in which interactions among individuals and small groups take place. Micro-level factors include immediate space and setting and group norms. Examples include personal social networks and the norms and expectations within those networks, as well as the conditions of physical spaces in which small groups interact and may engage in risk (e.g., availability of running water and prevention supplies in shooting galleries and other places drug users gather to use drugs). Micro-level structural interventions have included efforts to change the environments of risk in high-risk settings by increasing the presence of prevention information and materials and by developing programs targeting social norms that support harm reduction practices.44 In our model, macro, meso, and micro levels of structural influences cannot be defined a priori and may not follow a macro to micro order of influence. Events on a macro level may have direct influences on the meso and micro levels, and some events on the macro level may have direct influence on the individual Cycloheximide web through the availability of resources or direct incentives to perform or avoid a behavior. For example, an economic crisis on the macro level may lead to devalued currency, leaving individuals with fewer economic resources.AIDS Behav. Author manuscript; available in PMC 2011 December 1.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptLatkin et al.PageIndividuals’ perceptions of the national economic situation through the media and microsocial networks may also have indirect influences on their behaviors.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptDespite the fact that some factors are clearly more distal and broader than others, our model does not propose an empirical demarcation between one.Allow over-the-counter sales of sterile syringes without a prescription or allocation of millions of dollars for ART treatment or social mobilization efforts like Thailand’s 100 condom campaign),37-40 and national decisions to allow and finance harm reduction efforts (e.g. opiate replacement treatment programs like methadone or suboxone) for injection opiate users. “Meso evel” structural factors refer to systems within the more immediate institutions in which individuals or groups are involved and the contexts of those institutions.36 These factors link macro elements with elements that influence health from more proximal levels. Meso-level influences can include neighborhood context (e.g., deteriorated housing or transportation systems), community organizations such as facilities that provide access to health care, and features of the environment that may facilitate and impede risk such as the presence of bathhouses or “shooting galleries” in an area. Meso-level factors also include broad social networks (sometimes referred to as macro-networks) of particular groups, ranging from drug users or men who have sex with men (MSM) to organized community action groups, electronic networks of “friends,” and the social capital that comes with these networks. Structural interventions designed to address meso-level influences on HIV risk and susceptibility include network diffusion models,41-44 at-risk community mobilization efforts,45-47 and development of housing for chronically homeless drug users and others at risk for or infected with HIV.48 The term “micro” level, when used to describe structural factors, often refers to the immediate social and physical context in which interactions among individuals and small groups take place. Micro-level factors include immediate space and setting and group norms. Examples include personal social networks and the norms and expectations within those networks, as well as the conditions of physical spaces in which small groups interact and may engage in risk (e.g., availability of running water and prevention supplies in shooting galleries and other places drug users gather to use drugs). Micro-level structural interventions have included efforts to change the environments of risk in high-risk settings by increasing the presence of prevention information and materials and by developing programs targeting social norms that support harm reduction practices.44 In our model, macro, meso, and micro levels of structural influences cannot be defined a priori and may not follow a macro to micro order of influence. Events on a macro level may have direct influences on the meso and micro levels, and some events on the macro level may have direct influence on the individual through the availability of resources or direct incentives to perform or avoid a behavior. For example, an economic crisis on the macro level may lead to devalued currency, leaving individuals with fewer economic resources.AIDS Behav. Author manuscript; available in PMC 2011 December 1.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptLatkin et al.PageIndividuals’ perceptions of the national economic situation through the media and microsocial networks may also have indirect influences on their behaviors.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptDespite the fact that some factors are clearly more distal and broader than others, our model does not propose an empirical demarcation between one.
