Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Enfermagem

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

REVIEW • Rev. Bras. Enferm. 76 (1) • 2023 • https://doi.org/10.1590/0034-7167-2021-0853 copy

Multilevel model in the identification of behavioral and structural risk factors for HIV: integrative review

Modelo multinivel para la identificación de factores de riesgo comportamentales y estructurales del VIH: revisión integradora

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to investigate studies that adopted the multilevel analysis model to identify behavioral and structural risk factors associated with HIV infection.

Methods:

an integrative review of the literature with studies available in full, obtained from EMBASE, CINAHL, Pubmed, and Scopus, whose selected descriptors were the indexed terms: “HIV”, “multilevel analysis” and “behavior”.

Results:

the search resulted in 236 studies. Out of these, ten studies comprised the sample. Economic disadvantage, neighborhood characteristics, housing instability, incarceration, transactional sex, multiple partners, substance abuse, and age at first intercourse were classified as structural and behavioral risk factors for HIV. Reduced socioeconomic disadvantage, provision of housing stability, and condom use were associated with protective factors for HIV exposure.

Conclusions:

by applying the multilevel model in risk factor research studies, it was possible to identify the structural and behavioral elements of HIV risk.

Descriptors:
HIV; Multilevel Analysis; Behavior; Risk; Models Structural.

Title/Study number	Year/Country	Design/population	Multi-level model elements	HIV risk factors
A multilevel analysis of the determinants of high-risk sexual behaviour in Sub-Saharan Africa (E1)(⁴4 Uchudi J, Magadi M, Mostazir M. A multilevel analysis of the determinants of high-risk sexual behaviour in sub-Saharan Africa. J Biosoc Sci. 2012;44(3):289-311. https://doi.org/10.1017/S0021932011000654 https://doi.org/10.1017/S002193201100065... )	2012 Sub-Saharan Africa	Cross-sectional study (n=144,983); with women aged 15-49 and men aged 15-54/59	Factors related to micro- and macro-level involvement in high-risk sexual behaviors and sexual exposure	Involvement with multiple sexual partners and early initiation of sexual activity; exposure to media;
A qualitative study of young men who have sex with men and multilevel factors related to hiv risks in Malaysia (E2)(²¹21 Burch WJ, Hart GJ, Lim SH. A qualitative study of young men who have sex with men and multilevel factors related to HIV Risks in Malaysia. AIDS Educ Prev. 2018;30(2):85-95. https://doi.org/10.1521/aeap.2018.30.2.85 https://doi.org/10.1521/aeap.2018.30.2.8... )	2018 Malaysia	Qualitative study (n=24); with young people aged 18-25 years;	Explored the multi-level domains: perception and acceptance by family, friends, and society as men who have sex with men; gender roles; relationships; condom use; HIV and HIV testing	Lack of adequate sex education in schools; difficulty in buying condoms; lack of easily accessible and confidential tests in testing clinics; inability to reconcile sexuality with cultural and religious backgrounds; and social homophobia;
A Multilevel Analysis of Neighborhood Socioeconomic Disadvantage and Transactional Sex with Casual Partners Among Young Men Who Have Sex with Men Living in Metro Detroit(E3)(²²22 Bauermeister J, Eaton L, Stephenson R. A multilevel analysis of neighborhood socioeconomic disadvantage and transactional sex with casual partners among young men who have sex with men living in Metro Detroit. Behav Med. 2016;42(3):197-204. https://doi.org/10.1080/08964289.2015.1110560 https://doi.org/10.1080/08964289.2015.11... )	2016 USA	Cross-sectional study (n= 319), with young people aged 18 to 29 years;	Level 1: transactional sex with casual partner; HIV testing and status; substance use, demographic characteristics; Level 2: neighborhood and neighborhood economic disadvantage;	Young people living at high socioeconomic disadvantage; involvement in active transsexual with casual partners; socioeconomic neighborhood is associated with HIV risk behaviors
Relationships between neighborhood characteristics and current STI status among HIV-infected and HIV-uninfected women living in the Southern USA: a cross-sectional multilevel analysis (E4)(²³23 Haley DF, Kramer MR, Adimora AA, Haardörfer R, Wingood GM, Ludema C, et al. Relationships between neighborhood characteristics and current STI status among HIV-infected and HIV-uninfected women living in the Southern USA: a cross-sectional multilevel analysis. Sex Transm Infect. 2017;93(8):583-9. https://doi.org/10.1136 / sextrans-2016-052889 https://doi.org/10.1136 / sextrans-2016-... )	2017 USA	Cohort study (n=737) with women aged 25 to 60 years;	Associations between neighborhood characteristics and associations through Socioecological Framework analysis and controlled multilevel analysis;	Area level with higher social disorder (higher violent crime, vacant housing, poverty, STI prevalence); area level with social disadvantage (more alcohol outlets, renter-occupied housing);
Social disequilibrium and the risk of HIV acquisition: a multilevel study in Rural KwaZulu-Natal Province, South Africa (E5)(⁵5 Tomita A, Vandormael AM, Bärnighausen T, Oliveira T, Tanser F. Social disequilibrium and the risk of HIV acquisition: a multilevel study in Rural KwaZulu-Natal Province, South Africa. J Acquir Immune Defic Syndr. 2017;75(2):164-74. https://doi.org/10.1097/QAI.0000000000001349 https://doi.org/10.1097/QAI.000000000000... )	2017 South Africa	Cohort Study (n= 17,376), with men aged 15-54 years, and women aged 15-49 years;	Multilevel survival models to examine social determinants, HIV prevalence, and individual determinants	Access points with higher intensity of neighborhood migration among men; in women, higher intensity of neighborhood migration, youth, sexual initiation, contraception, circumcision, and social determinants; neighborhood characteristics are attributable to HIV risk;
Spatial patterns and associated factors of HIV Seropositivity among adults in Ethiopia from EDHS 2016: a spatial and multilevel Analysis (E6)(²⁴24 Hailu BA, Tadese F, Bogale GG, Molla A, Miherety BA, Beyene J. Spatial patterns and associated factors of HIV Soropositivity among adults in Ethiopia from EDHS 2016: a spatial and multilevel analysis. BMC Infect Dis. 2020;20:751. https://doi.org/10.1186/s12879-020-05456-y https://doi.org/10.1186/s12879-020-05456... )	2020 Ethiopia	Cross-sectional study (n=25,774) adults aged 15 to 59 years;	Analysis of spatial heterogeneity, and multilevel logistic, to identify factors associated with HIV	Place of residence was associated with HIV seropositivity; high age; individual sex, individuals exposed to high levels of media exposure, urban residence and smaller family size;
Sex ratio, poverty, and concurrent partnerships among men and women in the United States: a multilevel analysis (E7)(²⁵25 Adimora AA, Schoenbach VJ, Taylor EM, Khan MR, Schwartz RJ, Miller WC. Sex ratio, poverty, and concurrent partnerships among men and women in the United States: a multilevel analysis. Ann Epidemiol. 2013;23(11):716-9. https://doi.org/10.1016 / j.annepidem.2013.08.002 https://doi.org/10.1016 / j.annepidem.20... )	2013 United States of America	Cross-sectional study (n= 12,571) youth and adults aged 15 to 44 years;	Simultaneous analysis over the past 12 months regarding the County’s sex ratio (among the participants racial and ethnic group), percentage in poverty (among the respondent’s racial and ethnic group), and violent crime rate;	Age at first intercourse and substance abuse were associated with concurrency; sexual network patterns such as concurrent partnerships are critical determinants of HIV spread in the population; black men with a low sex ratio and high incarceration rates were more likely to have multiple partners;
Structural Efects on HIV Risk Among Youth: A Multi‑level Analysis (E8)(²⁶26 Miller RL, Strzyzykowski T, Lee KS, Chiaramonte D, Acevedo Polakovich I, Spring H. et al. Structural efects on HIV risk among youth: a multi level analysis. AIDS Behav. 2018;22(11):3451-67. https://doi.org/10.1007/s10461-018-2031-7 https://doi.org/10.1007/s10461-018-2031-... )	2018 Colombia	Cross-Sectional Study (n=1,793) with young people aged 12 to 24 years.	To confirm associations between: HIV status; concentrated community disadvantage; HIV structural stigma, sexual and gender minority structural stigma; community support for youth; neighborhood opportunity structures; early HIV stigma; HIV risk sexual relationships;	Disadvantage of concentrated community; residing in a state with failures to confer legal protections for sexual practices and gender minorities on youth participation in pro-social age activities was significant;
The relationship between economic deprivation, housing instability and transactional sex among women in North Carolina (HPTN 064) (E9)(²⁷27 Stoner MCD, Haley DF, Golin CE, Adimora AA, Pettifor A. The relationship between economic deprivation, housing instability and transactional sex among women in North Carolina (HPTN 064). AIDS Behav. 2019;23(11):2946-55. https://doi.org/10.1007 / s10461-019-02611-8 https://doi.org/10.1007 / s10461-019-026... )	2019 United States of America	Cohort study (n= 2,099) with women between 18 and 44 years old;	Relationship between area and individual level measures and transactional sex; and the relationship between transactional sex as an exposure and HIV risk related characteristics	Increased transactional sex was associated with food insecurity; housing instability, substance abuse, and partner incarceration; partner in incarceration was associated with HIV risk;
A multilevel analysis of the determinants and cross-national variations of HIV seropositivity in sub-Saharan Africa: Evidence from the DHS (E10)(¹⁰10 Magadi M, Desta M. A multilevel analysis of the determinants and cross-national variations of HIV seropositivity in sub-Saharan Africa: evidence from the DHS. Health Place. 2011;17(5):1067-83. https://doi.org:10.1016/j.healthplace.2011.06.004 https://doi.org:10.1016/j.healthplace.20... )	2011 Sub-Saharan Africa	Cross-sectional study (n= 174,592), with youth and adults aged 15-44 years;	Applied multilevel logistic regression models to explore individual and regional contextual and country levels of factors associated with HIV seropositivity risk;	Socioeconomic factors linked to transactional sex and vulnerability; women in their 30s, elementary school education; low media exposure; female-headed households;

Structural risk factors	Behavioral risk factors
Socioeconomic Disadvantage(¹⁰10 Magadi M, Desta M. A multilevel analysis of the determinants and cross-national variations of HIV seropositivity in sub-Saharan Africa: evidence from the DHS. Health Place. 2011;17(5):1067-83. https://doi.org:10.1016/j.healthplace.2011.06.004 https://doi.org:10.1016/j.healthplace.20... ,²²22 Bauermeister J, Eaton L, Stephenson R. A multilevel analysis of neighborhood socioeconomic disadvantage and transactional sex with casual partners among young men who have sex with men living in Metro Detroit. Behav Med. 2016;42(3):197-204. https://doi.org/10.1080/08964289.2015.1110560 https://doi.org/10.1080/08964289.2015.11... ) and Social Disorder(²³23 Haley DF, Kramer MR, Adimora AA, Haardörfer R, Wingood GM, Ludema C, et al. Relationships between neighborhood characteristics and current STI status among HIV-infected and HIV-uninfected women living in the Southern USA: a cross-sectional multilevel analysis. Sex Transm Infect. 2017;93(8):583-9. https://doi.org/10.1136 / sextrans-2016-052889 https://doi.org/10.1136 / sextrans-2016-... ,²⁶26 Miller RL, Strzyzykowski T, Lee KS, Chiaramonte D, Acevedo Polakovich I, Spring H. et al. Structural efects on HIV risk among youth: a multi level analysis. AIDS Behav. 2018;22(11):3451-67. https://doi.org/10.1007/s10461-018-2031-7 https://doi.org/10.1007/s10461-018-2031-... )	Transactional sex(¹⁰10 Magadi M, Desta M. A multilevel analysis of the determinants and cross-national variations of HIV seropositivity in sub-Saharan Africa: evidence from the DHS. Health Place. 2011;17(5):1067-83. https://doi.org:10.1016/j.healthplace.2011.06.004 https://doi.org:10.1016/j.healthplace.20... ,²²22 Bauermeister J, Eaton L, Stephenson R. A multilevel analysis of neighborhood socioeconomic disadvantage and transactional sex with casual partners among young men who have sex with men living in Metro Detroit. Behav Med. 2016;42(3):197-204. https://doi.org/10.1080/08964289.2015.1110560 https://doi.org/10.1080/08964289.2015.11... ,²⁷27 Stoner MCD, Haley DF, Golin CE, Adimora AA, Pettifor A. The relationship between economic deprivation, housing instability and transactional sex among women in North Carolina (HPTN 064). AIDS Behav. 2019;23(11):2946-55. https://doi.org/10.1007 / s10461-019-02611-8 https://doi.org/10.1007 / s10461-019-026... )
Neighborhood characteristics(⁵5 Tomita A, Vandormael AM, Bärnighausen T, Oliveira T, Tanser F. Social disequilibrium and the risk of HIV acquisition: a multilevel study in Rural KwaZulu-Natal Province, South Africa. J Acquir Immune Defic Syndr. 2017;75(2):164-74. https://doi.org/10.1097/QAI.0000000000001349 https://doi.org/10.1097/QAI.000000000000... ,²²22 Bauermeister J, Eaton L, Stephenson R. A multilevel analysis of neighborhood socioeconomic disadvantage and transactional sex with casual partners among young men who have sex with men living in Metro Detroit. Behav Med. 2016;42(3):197-204. https://doi.org/10.1080/08964289.2015.1110560 https://doi.org/10.1080/08964289.2015.11... -²³23 Haley DF, Kramer MR, Adimora AA, Haardörfer R, Wingood GM, Ludema C, et al. Relationships between neighborhood characteristics and current STI status among HIV-infected and HIV-uninfected women living in the Southern USA: a cross-sectional multilevel analysis. Sex Transm Infect. 2017;93(8):583-9. https://doi.org/10.1136 / sextrans-2016-052889 https://doi.org/10.1136 / sextrans-2016-... )	Multiple partners(⁵5 Tomita A, Vandormael AM, Bärnighausen T, Oliveira T, Tanser F. Social disequilibrium and the risk of HIV acquisition: a multilevel study in Rural KwaZulu-Natal Province, South Africa. J Acquir Immune Defic Syndr. 2017;75(2):164-74. https://doi.org/10.1097/QAI.0000000000001349 https://doi.org/10.1097/QAI.000000000000... ,²⁵25 Adimora AA, Schoenbach VJ, Taylor EM, Khan MR, Schwartz RJ, Miller WC. Sex ratio, poverty, and concurrent partnerships among men and women in the United States: a multilevel analysis. Ann Epidemiol. 2013;23(11):716-9. https://doi.org/10.1016 / j.annepidem.2013.08.002 https://doi.org/10.1016 / j.annepidem.20... )
Media exposure(⁴4 Uchudi J, Magadi M, Mostazir M. A multilevel analysis of the determinants of high-risk sexual behaviour in sub-Saharan Africa. J Biosoc Sci. 2012;44(3):289-311. https://doi.org/10.1017/S0021932011000654 https://doi.org/10.1017/S002193201100065... ,²⁴24 Hailu BA, Tadese F, Bogale GG, Molla A, Miherety BA, Beyene J. Spatial patterns and associated factors of HIV Soropositivity among adults in Ethiopia from EDHS 2016: a spatial and multilevel analysis. BMC Infect Dis. 2020;20:751. https://doi.org/10.1186/s12879-020-05456-y https://doi.org/10.1186/s12879-020-05456... )	Substance abuse(²³23 Haley DF, Kramer MR, Adimora AA, Haardörfer R, Wingood GM, Ludema C, et al. Relationships between neighborhood characteristics and current STI status among HIV-infected and HIV-uninfected women living in the Southern USA: a cross-sectional multilevel analysis. Sex Transm Infect. 2017;93(8):583-9. https://doi.org/10.1136 / sextrans-2016-052889 https://doi.org/10.1136 / sextrans-2016-... ,²⁵25 Adimora AA, Schoenbach VJ, Taylor EM, Khan MR, Schwartz RJ, Miller WC. Sex ratio, poverty, and concurrent partnerships among men and women in the United States: a multilevel analysis. Ann Epidemiol. 2013;23(11):716-9. https://doi.org/10.1016 / j.annepidem.2013.08.002 https://doi.org/10.1016 / j.annepidem.20... )
Lack of sex education(²¹21 Burch WJ, Hart GJ, Lim SH. A qualitative study of young men who have sex with men and multilevel factors related to HIV Risks in Malaysia. AIDS Educ Prev. 2018;30(2):85-95. https://doi.org/10.1521/aeap.2018.30.2.85 https://doi.org/10.1521/aeap.2018.30.2.8... ), difficulty in buying condoms(²¹21 Burch WJ, Hart GJ, Lim SH. A qualitative study of young men who have sex with men and multilevel factors related to HIV Risks in Malaysia. AIDS Educ Prev. 2018;30(2):85-95. https://doi.org/10.1521/aeap.2018.30.2.85 https://doi.org/10.1521/aeap.2018.30.2.8... )	Condom Accessibility(²¹21 Burch WJ, Hart GJ, Lim SH. A qualitative study of young men who have sex with men and multilevel factors related to HIV Risks in Malaysia. AIDS Educ Prev. 2018;30(2):85-95. https://doi.org/10.1521/aeap.2018.30.2.85 https://doi.org/10.1521/aeap.2018.30.2.8... )
Lack of testing(²¹21 Burch WJ, Hart GJ, Lim SH. A qualitative study of young men who have sex with men and multilevel factors related to HIV Risks in Malaysia. AIDS Educ Prev. 2018;30(2):85-95. https://doi.org/10.1521/aeap.2018.30.2.85 https://doi.org/10.1521/aeap.2018.30.2.8... )	Age at first sexual intercourse(²³23 Haley DF, Kramer MR, Adimora AA, Haardörfer R, Wingood GM, Ludema C, et al. Relationships between neighborhood characteristics and current STI status among HIV-infected and HIV-uninfected women living in the Southern USA: a cross-sectional multilevel analysis. Sex Transm Infect. 2017;93(8):583-9. https://doi.org/10.1136 / sextrans-2016-052889 https://doi.org/10.1136 / sextrans-2016-... ,²⁵25 Adimora AA, Schoenbach VJ, Taylor EM, Khan MR, Schwartz RJ, Miller WC. Sex ratio, poverty, and concurrent partnerships among men and women in the United States: a multilevel analysis. Ann Epidemiol. 2013;23(11):716-9. https://doi.org/10.1016 / j.annepidem.2013.08.002 https://doi.org/10.1016 / j.annepidem.20... )
Migration(⁵5 Tomita A, Vandormael AM, Bärnighausen T, Oliveira T, Tanser F. Social disequilibrium and the risk of HIV acquisition: a multilevel study in Rural KwaZulu-Natal Province, South Africa. J Acquir Immune Defic Syndr. 2017;75(2):164-74. https://doi.org/10.1097/QAI.0000000000001349 https://doi.org/10.1097/QAI.000000000000... )	Circumcision(⁵5 Tomita A, Vandormael AM, Bärnighausen T, Oliveira T, Tanser F. Social disequilibrium and the risk of HIV acquisition: a multilevel study in Rural KwaZulu-Natal Province, South Africa. J Acquir Immune Defic Syndr. 2017;75(2):164-74. https://doi.org/10.1097/QAI.0000000000001349 https://doi.org/10.1097/QAI.000000000000... )
Housing instability(²⁴24 Hailu BA, Tadese F, Bogale GG, Molla A, Miherety BA, Beyene J. Spatial patterns and associated factors of HIV Soropositivity among adults in Ethiopia from EDHS 2016: a spatial and multilevel analysis. BMC Infect Dis. 2020;20:751. https://doi.org/10.1186/s12879-020-05456-y https://doi.org/10.1186/s12879-020-05456... ,²⁷27 Stoner MCD, Haley DF, Golin CE, Adimora AA, Pettifor A. The relationship between economic deprivation, housing instability and transactional sex among women in North Carolina (HPTN 064). AIDS Behav. 2019;23(11):2946-55. https://doi.org/10.1007 / s10461-019-02611-8 https://doi.org/10.1007 / s10461-019-026... )	Individual Sex(²⁴24 Hailu BA, Tadese F, Bogale GG, Molla A, Miherety BA, Beyene J. Spatial patterns and associated factors of HIV Soropositivity among adults in Ethiopia from EDHS 2016: a spatial and multilevel analysis. BMC Infect Dis. 2020;20:751. https://doi.org/10.1186/s12879-020-05456-y https://doi.org/10.1186/s12879-020-05456... )
Imprisonment(²⁵25 Adimora AA, Schoenbach VJ, Taylor EM, Khan MR, Schwartz RJ, Miller WC. Sex ratio, poverty, and concurrent partnerships among men and women in the United States: a multilevel analysis. Ann Epidemiol. 2013;23(11):716-9. https://doi.org/10.1016 / j.annepidem.2013.08.002 https://doi.org/10.1016 / j.annepidem.20... ,²⁷27 Stoner MCD, Haley DF, Golin CE, Adimora AA, Pettifor A. The relationship between economic deprivation, housing instability and transactional sex among women in North Carolina (HPTN 064). AIDS Behav. 2019;23(11):2946-55. https://doi.org/10.1007 / s10461-019-02611-8 https://doi.org/10.1007 / s10461-019-026... )	Lack of legal protections for sexual practices(²⁶26 Miller RL, Strzyzykowski T, Lee KS, Chiaramonte D, Acevedo Polakovich I, Spring H. et al. Structural efects on HIV risk among youth: a multi level analysis. AIDS Behav. 2018;22(11):3451-67. https://doi.org/10.1007/s10461-018-2031-7 https://doi.org/10.1007/s10461-018-2031-... )

Structural Protection Factors	Behavioral protective factors
Accessibility to voluntary testing(⁴4 Uchudi J, Magadi M, Mostazir M. A multilevel analysis of the determinants of high-risk sexual behaviour in sub-Saharan Africa. J Biosoc Sci. 2012;44(3):289-311. https://doi.org/10.1017/S0021932011000654 https://doi.org/10.1017/S002193201100065... ,²¹21 Burch WJ, Hart GJ, Lim SH. A qualitative study of young men who have sex with men and multilevel factors related to HIV Risks in Malaysia. AIDS Educ Prev. 2018;30(2):85-95. https://doi.org/10.1521/aeap.2018.30.2.85 https://doi.org/10.1521/aeap.2018.30.2.8... )	Condom use(²2 Ministério da Saúde (BR). Boletim Epidemiológico HIV/Aids 2020 [Internet]. 2020 [cited 2021 Jul 5] Available from: http://www.aids.gov.br/pt-br/pub/2020/boletim-epidemiologico-hivaids-2020 http://www.aids.gov.br/pt-br/pub/2020/bo... ,²⁶26 Miller RL, Strzyzykowski T, Lee KS, Chiaramonte D, Acevedo Polakovich I, Spring H. et al. Structural efects on HIV risk among youth: a multi level analysis. AIDS Behav. 2018;22(11):3451-67. https://doi.org/10.1007/s10461-018-2031-7 https://doi.org/10.1007/s10461-018-2031-... )
Funding from Non-Governmental Organizations(²¹21 Burch WJ, Hart GJ, Lim SH. A qualitative study of young men who have sex with men and multilevel factors related to HIV Risks in Malaysia. AIDS Educ Prev. 2018;30(2):85-95. https://doi.org/10.1521/aeap.2018.30.2.85 https://doi.org/10.1521/aeap.2018.30.2.8... )	Individual autonomy and attitudes to sexual practices(⁴4 Uchudi J, Magadi M, Mostazir M. A multilevel analysis of the determinants of high-risk sexual behaviour in sub-Saharan Africa. J Biosoc Sci. 2012;44(3):289-311. https://doi.org/10.1017/S0021932011000654 https://doi.org/10.1017/S002193201100065... )
Reduce socioeconomic disadvantage, and provide housing stability(²²22 Bauermeister J, Eaton L, Stephenson R. A multilevel analysis of neighborhood socioeconomic disadvantage and transactional sex with casual partners among young men who have sex with men living in Metro Detroit. Behav Med. 2016;42(3):197-204. https://doi.org/10.1080/08964289.2015.1110560 https://doi.org/10.1080/08964289.2015.11... ,²⁷27 Stoner MCD, Haley DF, Golin CE, Adimora AA, Pettifor A. The relationship between economic deprivation, housing instability and transactional sex among women in North Carolina (HPTN 064). AIDS Behav. 2019;23(11):2946-55. https://doi.org/10.1007 / s10461-019-02611-8 https://doi.org/10.1007 / s10461-019-026... )	Alternative options to transactional sex(²²22 Bauermeister J, Eaton L, Stephenson R. A multilevel analysis of neighborhood socioeconomic disadvantage and transactional sex with casual partners among young men who have sex with men living in Metro Detroit. Behav Med. 2016;42(3):197-204. https://doi.org/10.1080/08964289.2015.1110560 https://doi.org/10.1080/08964289.2015.11... )
Explore vulnerable neighborhoods(²³23 Haley DF, Kramer MR, Adimora AA, Haardörfer R, Wingood GM, Ludema C, et al. Relationships between neighborhood characteristics and current STI status among HIV-infected and HIV-uninfected women living in the Southern USA: a cross-sectional multilevel analysis. Sex Transm Infect. 2017;93(8):583-9. https://doi.org/10.1136 / sextrans-2016-052889 https://doi.org/10.1136 / sextrans-2016-... )	Temporality in relationships(²³23 Haley DF, Kramer MR, Adimora AA, Haardörfer R, Wingood GM, Ludema C, et al. Relationships between neighborhood characteristics and current STI status among HIV-infected and HIV-uninfected women living in the Southern USA: a cross-sectional multilevel analysis. Sex Transm Infect. 2017;93(8):583-9. https://doi.org/10.1136 / sextrans-2016-052889 https://doi.org/10.1136 / sextrans-2016-... )
Exploring mechanisms between social connections and HIV acquisition(⁵5 Tomita A, Vandormael AM, Bärnighausen T, Oliveira T, Tanser F. Social disequilibrium and the risk of HIV acquisition: a multilevel study in Rural KwaZulu-Natal Province, South Africa. J Acquir Immune Defic Syndr. 2017;75(2):164-74. https://doi.org/10.1097/QAI.0000000000001349 https://doi.org/10.1097/QAI.000000000000... )	Increased use of health resources(²⁶26 Miller RL, Strzyzykowski T, Lee KS, Chiaramonte D, Acevedo Polakovich I, Spring H. et al. Structural efects on HIV risk among youth: a multi level analysis. AIDS Behav. 2018;22(11):3451-67. https://doi.org/10.1007/s10461-018-2031-7 https://doi.org/10.1007/s10461-018-2031-... )
Community support, engagement in community activities(²⁶26 Miller RL, Strzyzykowski T, Lee KS, Chiaramonte D, Acevedo Polakovich I, Spring H. et al. Structural efects on HIV risk among youth: a multi level analysis. AIDS Behav. 2018;22(11):3451-67. https://doi.org/10.1007/s10461-018-2031-7 https://doi.org/10.1007/s10461-018-2031-... )	Behavioral interventions(²⁵25 Adimora AA, Schoenbach VJ, Taylor EM, Khan MR, Schwartz RJ, Miller WC. Sex ratio, poverty, and concurrent partnerships among men and women in the United States: a multilevel analysis. Ann Epidemiol. 2013;23(11):716-9. https://doi.org/10.1016 / j.annepidem.2013.08.002 https://doi.org/10.1016 / j.annepidem.20... )

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

Acompanhe os números deste periódico no seu leitor de RSS