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:
- no definition
- no operational guidance
- no evidence
Hargreaves notes that effective new health interventions tend to increase health disparities by increasing the health of wealthier groups faster than that of poor groups. As HIV is increasingly associated with marginalised and hard-to-reach populations, it is necessary to identify, prioritise, fund and deliver strategies that:
- ensure that basic programmatic activities benefit the hard to reach
- target the social determinants of HIV transmission through HIV-specific interventions
- catalyse HIV-sensitive development
At the same time, Hargreaves says, we must strengthen the evidence base with monitoring, evaluation and outcome research. Here, he draws on findings from interventions such as Stepping Stones, IMAGE and Swa Koteka.