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

Content for the risk environment model adapted from Rhodes and Simic¹⁴ and Strathdee et al.¹⁵

Abbreviations: HIV, human immunodeficiency virus; STI, sexually transmitted infections.