This set of five position papers was co-commissioned by STRIVE and AIDSTAR-One to address critical issues within the field of structural interventions. The series was launched at a panel presentation hosted by PEPFAR in Washington, DC on 11 September 2013 (selected presentations are available to download here).
The papers present both academic and field-based perspectives on key concepts and definitions, operational approaches, programmatic experience and the current evidence linking structural factors to HIV risk.
Click on each paper below to download the PDF.
Lessons from the past 30 years point to three key objectives for behaviour-change HIV prevention efforts:
- address the broader structures shaping behavioural risk and vulnerability
- tailor responses to the factors affecting the target population's vulnerability
- ensure that multiple factors can be addressed when needed
This paper provides definitions of key terms and concepts to help in the operationalization of such approaches.
Paul Pronyk and Brian Lutz
Over the past decade, an increasing number of practical interventions have successfully addressed HIV’s structural factors. This paper profiles such efforts and their effects on HIV-related behavioural and biological outcomes. The lessons that emerge stress the importance of cross-sectoral approaches in the global response to HIV.
Lori Heise and Charlotte Watts
This paper examines evidence linking structural factors to HIV risk. It addresses research gaps, including the pathways through which factors affect HIV vulnerability and interaction among such factors. Advantages of taking a 'structurally informed' approach to HIV planning and implementation include influencing clustered risk factors and multiple outcomes, and opportunities for co-financing.
James R. Hargreaves
Hargreaves proposes a three-pronged structural approach to HIV prevention, which overlaps with the investment framework proposed by UNAIDS in 2011:
- targeting interventions to enhance equity of HIV prevention
- interrupting the causal pathway from social determinants to risk through critical enabler interventions
- addressing structural factors directly through HIV-sensitive, cross-sectoral development
Cynthia Bowa and Timothy L. Mah
Global guidance acknowledges the importance of structural interventions to tackle HIV, but evidence of their effectiveness lags behind that of other means of prevention. This paper discusses the challenges to implementation at the community and national levels using the experience of PEPFAR and USAID in Zambia. The authors propose several ways to speed up implementation of structural interventions.