Strengthening the enabling environment for women and girls: what is the evidence in social and structural approaches in the HIV response?

Hardee, K; Gay, J; Croce-Galis, M; Peltz, A Journal of the International AIDS Society, 2015;

The sociocultural and political environment in which women live can enable or inhibit their ability to protect themselves from acquiring HIV. How best can we expand public health approaches to address the social and structural drivers that affect the environment in which behaviour occurs?

This paper examines the evidence related to six key social and structural drivers of HIV for women:

  • transforming gender norms
  • addressing violence against women (VAW)
  • transforming legal norms to empower women
  • promoting women’s employment, income and livelihood opportunities
  • advancing education for girls and reducing stigma and discrimination
  • reducing stigma and discrimination

For each driver, the authors review the evidence of successful or promising social and structural interventions. They base their analysis on peer-reviewed published research and study reports with clear and transparent data on the effectiveness of interventions. 

Scope of evidence

The evidence of what works and what is promising among structural interventions includes 64 studies and evaluations grouped under 19 interventions. Of these, 40 sstudies and evaluations seven interventions that demonstrate positive impact, while 24 support 12 promising interventions.

Interventions and outcomes 

Table summarises the 19 interventions defined by the selection criteria as ‘‘works’’ or ‘‘promising,’’ and the outcomes related to each.


These structural interventions have:

  • increased HIV-protective behaviours
  • created more gender-equitable relationships and decreased violence
  • improved services for women
  • increased widows’ ability to cope with HIV
  • reduced behaviour that increases HIV risk, particularly among young people

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