| A multilevel analysis of the determinants of high-risk sexual behaviour in Sub-Saharan Africa (E1)(4) |
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)(21) |
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)(22) |
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)(23) |
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)(5) |
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)(24) |
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)(25) |
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)(26) |
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)(27) |
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)(10) |
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; |
Multilevel model in the identification of behavioral and structural risk factors for HIV: integrative review
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