Structural approaches for prevention of sexually transmitted HIV in general populations: definitions and an operational approach

Journal of the International AIDS Society

Amanda W. Singer , Sheri D. Weiser, Sandra I. McCoy

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With current calls for structural approaches to HIV, as part of combination HIV prevention, there is a unique opportunity to define a structural approach to HIV prevention that incorporates our knowledge of the social world and lessons from past efforts.

Clear lessons identified from past efforts include:

  •       a need to address influential social, economic and legal structures
  •       tailoring efforts to local contexts
  •       addressing multiple influencing factors in combination

Despite these insights there remains a pervasive strategy to try and achieve sexual behaviour change through single, decontextualised interventions or sets of activities.

Within the broad concept of a structural approach to HIV it is important to define and distinguish:

  1. “structural factors” – any number of elements (other than knowledge) which influence risk and vulnerability
  2. “structural drivers” – reserved for situations where an empirically established relationship to a target group is known.

Future HIV prevention efforts must address the multiple factors influencing risk and vulnerability, and they must do so in ways tailored to particular settings. Clarity on the concepts, terminology and approaches that can allow structural HIV prevention efforts to achieve this is therefore essential to improve the (social) science of HIV prevention.

Institutions change when new rules, norms or binding expectations are established. Existing funding sources and public expectations may currently provide institutional pressure to continue HIV programming as usual – leading to short term, oversimplified, information-driven prevention strategies."




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