Table 1.
Human immunodeficiency virus risk environment model for drug-using women with histories of partner violence
| Risk environment | Micro-environmental | Macro-environmental |
|---|---|---|
| Physical | • Homelessness | • Drug trafficking and distribution routes |
| • Housing instability | • Deportation | |
| • Prisons/incarceration | • Geographical shifts in population | |
| • Drug use locations | ||
| Social | • Relationship and network dynamics | • Stigma and discrimination |
| • Peer norms | • Social marginalization | |
| • Physical/sexual violence | • Exposure to conflict or disasters | |
| • Childhood sexual abuse | • Ethnic or racial disparities | |
| • Community attitudes | • Gender inequalities | |
| • Local policing practices (eg, police mistreatment, arrests) | • Social and cultural norms | |
| Economic | • Cost of male and female condoms, syringes, medication | • Scarcity of health and social services revenue and spending |
| • Few income generation and employment opportunities | • Employment practices | |
| • Survival sex work | • Economic development | |
| • Cost of health care | ||
| Political | Ensuring widespread coverage of: | Laws and policies governing: |
| • HIV/STI testing and counseling | • Protection of human and health rights | |
| • Antiretroviral therapy | • Violence against women | |
| • Housing assistance for drug users, abused women | • Possession of drugs | |
| • Sterile needles and syringes | • Syringe access and exchange | |
| • Drug treatment | • Free highly active antiretroviral therapy coverage | |
| • Male and female condoms | • Drug treatment |