Multiple levels of analysis and intervention in HIV prevention science: exemplars and directions for new research.

The need to continue the scientific development of evidence-based HIV-1 prevention strategies is clear. The epidemic continues to rage out of control, and a vaccine against HIV-1 is nowhere in sight. We think that it is important to consider the influence of multiple social units on HIV risk behavior. In this article, we use ecological theory to outline multiple levels of analysis at which preventive interventions can be conceptualized. These levels include the individual, dyadic/small group, organizational, community, and societal/cultural. We discuss advantages and disadvantages of locating HIV risk at each level, and provide exemplars of HIV prevention for each in an effort to encourage HIV prevention scientists to consider the level at which they are locating the determinants of HIV risk behavior when conducting research. We conclude by stating that scientists and research funding has favored the individual level of analysis, but that to be most successful, the field of HIV prevention science should address risk behavior at all levels of analysis.