Background: Targeting men is essential in stemming the heterosexual transmission of HIV and although much attention has been given to the individual and familial factors that influence male sexual behavior, the role of community factors in shaping male sexual behavior remains poorly understood. Objectives: We will estimate the influence of several dimensions of the community environment on the sexual behavior of heterosexual males in four countries: Ghana, Nigeria, Zambia and Zimbabwe. Data and Method: The analysis samples are sexually active males (15-54) from the latest Demographic and Health Surveys from Ghana (2003), Nigeria (2003) and Zambia (2001-02) and Zimbabwe (1999). Community level variables representing economic prosperity, gender norms, prevailing demographic and sexual behaviors, and exposure to health care messages in the community will be examined. A multilevel modeling strategy will be applied to identify the role of community level characteristics in shaping male sexual behavior. Significance: Previous studies of male sexual behavior have examined only the role of single elements of the community; this research is innovative in it's conceptualization of a holistic view of the community, examining the role of economic, social and normative community characteristics in determining male sexual behavior. This research will provide information on the associations between characteristics of a community's physical, behavioral, social and normative environment and male sexual behavior, and will demonstrate ways in which community factors are mediated by individual characteristics to shape individual sexual behavior, providing new information that will directly influence the development of health interventions aimed at heterosexual males. In addition to strengthening the scientific field of community influences on health, the research will generate interest in examining community influences on other health outcomes, and will lead to a greater motivation to improve the collection of community level data. The innovative methodology and conceptualization of the community can be employed to examine other health outcomes in both domestic and international settings. The research will also identify community characteristics that can be harnessed in the development of public health interventions, strengthening public health practice for the improvement of program and policy aimed at reducing heterosexual HIV transmission. ? ? ? ?
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