Operationalising structural programming for HIV/AIDS prevention and treatment

Principles, examples and evidence to answer the big question: How do we put structural approaches into practice?

In a presentation at the 2012 AIDS Conference, James Hargreaves addresses the three key barriers to effective structural programming:

Transcriptions: HIV, science and the social

A new online forum opens up debate at the critical intersection of HIV/AIDS, global health and social science.

Transcriptions was launched recently as part of Somatosphere, a collaborative website combining medical anthropology, science and technology studies, cultural psychiatry, psychology and bioethics. 


Young people aged 15 to 24 years accounted for an estimated 40% of all new HIV infections among adults worldwide in 2009. According to the World Health Organisation (WHO), there are more than 5 million young people living with HIV/AIDS around the world. Prevention efforts must tackle the upstream factors that make adolescents vulnerable to HIV.

STRIVE brings together a strong portfolio of research on adolescents and HIV. Projects pose questions such as:

The cultural challenge of HIV/AIDS

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The Lancet series on HIV and men who have sex with men (MSM) examines scientific advances alongside the cultural and political dimensions of HIV/AIDS.

The editorial by Pamela Das and Richard Horton argues that structural elements of the HIV epidemic, such as stigma and criminalisation, have been neglected in the pursuit of technical solutions.

Working towards more accurate research on HIV stigma

Measuring the impact of stigma as a global driver of HIV involves considerable conceptual and technical challenges. The diversity of research on stigma matches its complexity as a social and structural phenomenon – HIV stigma comes in many different forms, exists in all kinds of contexts and produces a wide range of consequences, often intersecting with other kinds of social stigma.

Transactional sex and HIV incidence in a cohort of young women in the Stepping Stones trial

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Transactional sex elevates young women’s risk of HIV infection, independent of partner number or age.

This paper proposes a more complex investigation of transactional sex, often subject to overly simple measures and arbitrary definitions. For example, research tends to conflate material gain and age difference between partners.

Addressing social drivers of HIV/AIDS: Some conceptual, methodological, and evidentiary considerations

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The patterns of behaviour that shape vulnerability to HIV arise from combinations of structural drivers.

Social science approaches must be more fully incorporated into the global response to HIV - this is now widely recognised. In this paper, the aids2031 Social Drivers Working Group draws attention to the intersection of specific social, economic and political contexts that combine to shape the structural drivers of HIV.

Transitioning care, support, and treatment services for adolescents living with HIV

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Technical report on care and treatment issues affecting adolescents living with HIV (ALHIV) in Botswana, Kenya and Zambia.

The report contends that there is a lack of consistency in services or monitoring for ALHIV, who are underserved by the gap between pediatric and adult care, without services specifically targeting adolescents.

The report covers the following areas:


Technical Brief: Measuring HIV stigma and discrimination

To understand how HIV stigma operates and how it can be reduced, researchers need a standardised measurement framework. 

The importance of addressing gender inequality in efforts to end vertical transmission of HIV

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Programmes to prevent mother to child transmission of HIV (PMTCT) are still being hampered by gender inequality. This is an upstream issue that this paper argues must be incorporated into PMTCT by policymakers and implementers.  

The paper highlights how gender inequality affects the ability of women and girls to protect themselves from HIV, prevent unintended pregnancies and access and continue to use HIV prevention, care and treatment services.