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This article presents a conceptual framework for the study of the distribution and determinants of human immunodeficiency virus (HIV) infection in populations, by combining demographic and epidemiological approaches. The proximate-determinants framework has been applied extensively in the study of fertility and child survival in developing countries. Key to the framework is the identification of a set of variables, called "proximate determinants," that can be influenced by changes in contextual variables or by interventions and that have a direct effect on biological mechanisms to influence health outcomes. In HIV research, the biological mechanisms are the components that determine the reproductive rate of infection. The proximate-determinants framework can be used in study design, in the analysis and interpretation of risk factors or intervention studies that include both biological and behavioral data, and in ecological studies.
Boerma et al. (Wed,) studied this question.