Impact case study: Prioritising combination HIV prevention for adolescent girls and young women in South Africa

Adolescent girls and young women in southern Africa and particularly South Africa currently constitute the population most vulnerable to HIV infection. Many social factors contribute to this risk, among them widespread gender inequalities and the high prevalence of intimate partner and other forms of violence. Oral pre-exposure prophylaxis (PrEP) offers an effective new HIV prevention tool that women could potentially control.

Technical brief: A moment of convergence: STRIVE and the Sustainable Development Goals

In 2011, STRIVE was established to develop an alternative perspective on fighting the HIV epidemic. This mandate has compelled us to think differently about how to achieve greater impact and cost efficiencies. 

STRIVE's research has focused on how to address upstream risk factors that HIV shares with multiple development outcomes. We have focused on factors such as:

Technical brief: Biomedical and structural prevention: STRIVE in the era of 'cascades'

Despite advances, an unmet need remains for HIV prevention, both through primary prevention through treatment for HIV negative individuals and secondary prevention through treatment for HIV positive individuals. This need is urgent in key populations such as sex workers, men who have sex with me, prisoners and people who use drugs, transgender people and adolescent girls and young women in sub-Saharan Africa.

A number of direct biomedical mechanisms have proven efficacy in preventing transmission at the biological level:

Evidence brief: Samata intervention to increase secondary school completion and reduce child marriage among adolescent girls from marginalised communities

The Samata trial assessed the impact of a multi-level structural and norms-based intervention developed by the Indian not-for-profit organisation, Karnataka Health Promotion Trust (KHPT). The trial was designed to reduce secondary school dropout and child marriage among marginalised scheduled caste/scheduled tribe (SC/ST) adolescent girls living in rural settings in South India. 

A number of structural and norms-based factors function as drivers of under-age marriage, early sexual debut and school dropout.

Technical brief: Social Norms

A number of structural inequalities and harmful practices are associated with increased HIV vulnerability. The concept of social norms provides a way to understand what sustains these practices and structures. By addressing problematic norms, it is possible to challenge these structures and thus reduce HIV risk.

Technical brief: Alcohol and HIV risk

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Hazardous alcohol use contributes to the acquisition of HIV through sexual risk and speeds the progression of the disease.

Strategies exist to successfully reduce the harms caused by hazardous alcohol use, including HIV, but these have focused on individual-level interventions while neglecting the powerful role of unfettered alcohol availability, low prices and heavy advertising and promotion in low- and middle-income countries. 

Technical brief: Co-financing for development synergies

Upstream structural barriers undermine the potential of HIV programmes to deliver on ambitious targets to prevent new infections and save lives. Interventions addressing these upstream factors are considered to be beyond the remit of the HIV response and too expensive for the HIV budget. This reflects conventional priority-setting and financing frameworks that consider only HIV outcomes and budgets.

Technical brief: HIV-related stigma and discrimination

Research confirms that reducing HIV-related stigma is critical to the success of prevention, care and treatment efforts.

Impact case study: Question on transactional sex in the DHS

As of 2015, the Demographic and Health Surveys (DHS) include improved questions to capture the practice of transactional sex for women and men. Similar questions are now included in the Violence against Children surveys (VACS), evaluations of the Transfer project and other cash transfer studies in South Africa and Tanzania and numerous individual studies including at least one surveillance site. As a result, survey data can be expected to shed light on:

Conference report: Successfully tackling the structural drivers of HIV

We will post the report of our one-day pre-conference session at AIDS 2018 on this page. Meanwhile, you can read about the highlights here.