Fferences in HIV risk behaviors. Macro-settings comprise larger geographic areas such as cities, states, or countries. Within macro level settings, HIV prevalence, laws and policies on drug use and commercial sex, economic conditions, and political leadership may have significantly influenced HIV incidence rates. The “success” stories of HIV prevention in Uganda and Thailand exemplify efforts at the macro level, but the achievements of these programs were also due to the allocation of resources and the activation of concerted influence and control processes at other levels. Though policies and resources were prescribed at the macro level, the programs were successful in reaching micro social environments.61 Inter-individual Processes Inter-individual processes in the model can be viewed as the direct interaction of people with their immediate physical, social, and societal environments. Through these processes, material resources and information flow from larger social structures to individuals 62 and from individuals to their micro-structural contexts. Further, individuals within small networks may influence the macro level through organized efforts to demand changes in policies and allocations of resources. These macro level changes will in turn influence meso and micro level factors and eventually change the immediate social context where individuals interact.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptAIDS Behav. Author manuscript; available in PMC 2011 December 1.Latkin et al.PageKey factors in the interaction between structural factors and individuals are social influence and control processes. Social influence and control may include enforcement of laws and policies. Arresting drug users for carrying syringes or clients and commercial sex workers for carrying condoms are social control mechanisms that may increase risk behaviors.63 Other factors such as the behaviors of social network members, including their reactions to other individuals’ behaviors, their modeling of behavior, and their provision of information, social rewards, threats of punishment and GGTI298 biological activity breaking ties all greatly influence individuals’ cognitive and affective processes and subsequent behaviors. Social influences are not unidirectional. Usually, partners and peer groups negotiate resources and risk behaviors. Patients or clients and health providers negotiate HIV testing. Disclosure of HIV status and sexual orientation among dyads and families is often a negotiation process. These negotiations may be overt or more subtle forays to determine how others will react to disclosure or risk reduction practices.64 The ties between individual and structural factors by way of inter-individual processes are bidirectional. They can involve loose or tight connections, emergent properties, feedback interactions, or CPI-455 site diminishing returns through entropy. Within-individual Cognitive and Affective Processes and Individual Attributes The proposed model acknowledges that cognitive and affective processes of the individual are malleable. These processes involve cognitive constructions and affect regulation. Key cognitive constructions for the individual that shape identity and social roles include gender, ethnicity, and sexuality. Perceived norms and social identities are constructed with constant feedback from the social environment. The same occurs with risk perceptions and definitions of safer practices. The meanings developed through these processes i.Fferences in HIV risk behaviors. Macro-settings comprise larger geographic areas such as cities, states, or countries. Within macro level settings, HIV prevalence, laws and policies on drug use and commercial sex, economic conditions, and political leadership may have significantly influenced HIV incidence rates. The “success” stories of HIV prevention in Uganda and Thailand exemplify efforts at the macro level, but the achievements of these programs were also due to the allocation of resources and the activation of concerted influence and control processes at other levels. Though policies and resources were prescribed at the macro level, the programs were successful in reaching micro social environments.61 Inter-individual Processes Inter-individual processes in the model can be viewed as the direct interaction of people with their immediate physical, social, and societal environments. Through these processes, material resources and information flow from larger social structures to individuals 62 and from individuals to their micro-structural contexts. Further, individuals within small networks may influence the macro level through organized efforts to demand changes in policies and allocations of resources. These macro level changes will in turn influence meso and micro level factors and eventually change the immediate social context where individuals interact.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptAIDS Behav. Author manuscript; available in PMC 2011 December 1.Latkin et al.PageKey factors in the interaction between structural factors and individuals are social influence and control processes. Social influence and control may include enforcement of laws and policies. Arresting drug users for carrying syringes or clients and commercial sex workers for carrying condoms are social control mechanisms that may increase risk behaviors.63 Other factors such as the behaviors of social network members, including their reactions to other individuals’ behaviors, their modeling of behavior, and their provision of information, social rewards, threats of punishment and breaking ties all greatly influence individuals’ cognitive and affective processes and subsequent behaviors. Social influences are not unidirectional. Usually, partners and peer groups negotiate resources and risk behaviors. Patients or clients and health providers negotiate HIV testing. Disclosure of HIV status and sexual orientation among dyads and families is often a negotiation process. These negotiations may be overt or more subtle forays to determine how others will react to disclosure or risk reduction practices.64 The ties between individual and structural factors by way of inter-individual processes are bidirectional. They can involve loose or tight connections, emergent properties, feedback interactions, or diminishing returns through entropy. Within-individual Cognitive and Affective Processes and Individual Attributes The proposed model acknowledges that cognitive and affective processes of the individual are malleable. These processes involve cognitive constructions and affect regulation. Key cognitive constructions for the individual that shape identity and social roles include gender, ethnicity, and sexuality. Perceived norms and social identities are constructed with constant feedback from the social environment. The same occurs with risk perceptions and definitions of safer practices. The meanings developed through these processes i.
