Beyond the Individual: The Roles of Social and Structural Contexts in HIV Prevention and HIV Acquisition in the United States

The present dissertation leverages the utility of analyzing a variety of secondary data sources to explore relationships between qualities of social and structural environments and HIV-related outcomes via a social-ecological approach. Advances in HIV outcomes for vulnerable, high-risk populations, e.g., African-American/Black gay, bisexual, and other men who have sex with men (BMSM), have been stymied by social and behavioral scientists’ tendency to primarily call upon individual-behavioral factors to explain the elevated rates of HIV observed within BMSM communities. This dissertation employs a broader analytical lens to explore relationships between social and structural variables with HIV acquisition and other key HIV-related outcomes (Studies 1 and 2). This dissertation also uses social media data to garner insights about the general public’s understandings of, and attitudes toward, extant HIV prevention tools. Location-based social media data are used to link attitudes toward HIV prevention tools with various social and structural characteristics of the geographic locations from where the content originates (Study 3). The results of the three studies indicate that there are real HIV prevention and acquisition considerations for social- and structural-level variables, such that factors at these levels have significant main and interactive associations with key HIV prevention, HIV risk behavior, and HIV acquisition variables. Taken together, the results indicate that HIV prevention and care strategies should not treat HIV as an independent social problem. Instead, future interventions must be multi-level in nature, with goals of positive behavioral as well as social and structural change