STRIVE Tackling the structural drivers of HIV

Upstream structural barriers undermine the potential of HIV programmes to deliver on ambitious targets to prevent new infections and save lives. Interventions addressing these upstream factors are considered to be beyond the remit of the HIV response and too expensive for the HIV budget. This reflects conventional priority-setting and financing frameworks that consider only HIV outcomes and budgets.

With shrinking international HIV funding on one hand, and the wide range of priorities established by the Sustainable Development Goals (SDGs) on the other hand, development interventions with multiple outcomes provide an opportunity for greater value for money. Yet, opportunities to realise synergies with non-HIV investments tend to be missed due to:

• a lack of data on their multiple outcomes
• the dominance of single outcome cost-effectiveness frameworks
• weak incentives for joint financing between sectors

Several policies in non-health sectors are likely to have HIV impacts and implications for the uptake of HIV services, just as HIV interventions can have downstream socio-economic impacts. Given the institutional frameworks and sioled nature of government sectors and development funders, we cannot assume that non-HIV sectors and funders will consider the spill-over of their policies and programmes on HIV, or vice versa.

This technical brief presents the existing evidence and draws upon STRIVE examples to arrive at policy recommendations.