1.Latkin et al.PageReception to HIV testing also depends on how different individuals, groups, and organizations interact in immediate and broader settings (social interconnectedness). At the micro level, interactions that can affect HIV testing behavior involve relationships among staff in the testing facility. The competing buy T0901317 priorities and responsibilities of staff at an HIV testing site, whether a clinic, emergency department or a bar, may deter interpersonal connections necessary to carry out HIV testing objectives.79 Heavy workloads may make health care providers reluctant to recommend HIV testing. This hinders opportunities for testing among persons at risk, even when individuals have access to health care and other services.88 Other interpersonal connections that can influence individuals’ HIV testing behavior are their interactions within their networks and communities. Individuals’ interactions with their immediate network and the larger community provide resources (e.g. referrals or information) and act as informal sources of social influence (e.g., role models) and control (e.g., social segregation or integration mechanisms).89 Program developers have taken advantage of these spontaneous connections to increase HIV testing uptake. For example, the CDC has funded CBOs to provide incentives for at-risk individuals to persuade members of their immediate networks to request an HIV test.90,91 Other examples of interventions making use of spontaneous social connections are social network and Actidione site community-based programs.92 Informal social influences also operate within immediate networks (e.g., friendship groups) or broader networks (e.g., neighborhoods) by providing social perceptions about HIV, the behaviors associated with HIV risk (e.g., sex, drug use), and the most affected groups (e.g., MSM, drug users, sex workers). Similarly, informal sources of support and control influence HIV-related settings (e.g., availability of spaces and times to engage in healthy or risky behaviors).93 However, changes in settings can change social control effects (e.g., greater availability of services in the community creates more positive HIV testing norms).16 Broader and more distal informal social influences on HIV testing include the endorsement or disapproval from role models including religious, political, or cultural leaders. Finally, HIV testing behavior can depend on interactions among organizations at the county, state, national, and even multinational levels. These include organizations involved in HIV testing development, provision, and promotion (e.g., technology, research, public health and medical groups), organizations that represent the interests of potential clients and affected individuals (e.g., human rights groups), and organizations that develop HIV testing policies (e.g., legislative entities). Interactions among macro level organizations can ultimately influence resource distribution and allocation, scientific and technological development, formal control, and settings. Social interactions at the macro level affect such diverse factors as the types of HIV tests available, the way HIV tests are provided, the decision rules for testing a person for HIV, the allocation of HIV testing resources among different communities, and the medical and legal consequences of testing positive for HIV. Interconnections at this level, therefore, strongly determine other structural influences on HIV testing and ultimately affect both individuals’.1.Latkin et al.PageReception to HIV testing also depends on how different individuals, groups, and organizations interact in immediate and broader settings (social interconnectedness). At the micro level, interactions that can affect HIV testing behavior involve relationships among staff in the testing facility. The competing priorities and responsibilities of staff at an HIV testing site, whether a clinic, emergency department or a bar, may deter interpersonal connections necessary to carry out HIV testing objectives.79 Heavy workloads may make health care providers reluctant to recommend HIV testing. This hinders opportunities for testing among persons at risk, even when individuals have access to health care and other services.88 Other interpersonal connections that can influence individuals’ HIV testing behavior are their interactions within their networks and communities. Individuals’ interactions with their immediate network and the larger community provide resources (e.g. referrals or information) and act as informal sources of social influence (e.g., role models) and control (e.g., social segregation or integration mechanisms).89 Program developers have taken advantage of these spontaneous connections to increase HIV testing uptake. For example, the CDC has funded CBOs to provide incentives for at-risk individuals to persuade members of their immediate networks to request an HIV test.90,91 Other examples of interventions making use of spontaneous social connections are social network and community-based programs.92 Informal social influences also operate within immediate networks (e.g., friendship groups) or broader networks (e.g., neighborhoods) by providing social perceptions about HIV, the behaviors associated with HIV risk (e.g., sex, drug use), and the most affected groups (e.g., MSM, drug users, sex workers). Similarly, informal sources of support and control influence HIV-related settings (e.g., availability of spaces and times to engage in healthy or risky behaviors).93 However, changes in settings can change social control effects (e.g., greater availability of services in the community creates more positive HIV testing norms).16 Broader and more distal informal social influences on HIV testing include the endorsement or disapproval from role models including religious, political, or cultural leaders. Finally, HIV testing behavior can depend on interactions among organizations at the county, state, national, and even multinational levels. These include organizations involved in HIV testing development, provision, and promotion (e.g., technology, research, public health and medical groups), organizations that represent the interests of potential clients and affected individuals (e.g., human rights groups), and organizations that develop HIV testing policies (e.g., legislative entities). Interactions among macro level organizations can ultimately influence resource distribution and allocation, scientific and technological development, formal control, and settings. Social interactions at the macro level affect such diverse factors as the types of HIV tests available, the way HIV tests are provided, the decision rules for testing a person for HIV, the allocation of HIV testing resources among different communities, and the medical and legal consequences of testing positive for HIV. Interconnections at this level, therefore, strongly determine other structural influences on HIV testing and ultimately affect both individuals’.