HIV risk and the alcohol environment: advancing an ecological epidemiology for HIV/AIDS

The study of individual risk factors is inadequate to address the current public health challenges associated with HIV/AIDS. Rather, an ecological epidemiological study of HIV/AIDS is needed to address these challenges. A socioecological framework has been proposed for HIV/AIDS, including influences at the individual level, the interpersonal level, the neighborhood level, and the societal level. This framework provides the basis for a conceptual model with specific risk factors at each of these levels and cross-level associations. The nature of the associations also is important, in particular the assumption that the neighborhood alcohol environment exerts its effect on HIV risk through both direct and indirect pathways.