Structural approaches to HIV prevention

• Published in: The Lancet (British edition) Vol. 372; no. 9640; pp. 764 - 775
• Main Authors: Gupta, Geeta Rao, Parkhurst, Justin O, Ogden, Jessica A, Aggleton, Peter, Mahal, Ajay
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 2008; Lancet
• Subjects: Behavior Therapy - methods; Biological and medical sciences; Community Health Services - organization & administration; Community Health Services - trends; Condoms - utilization; Female; General aspects; HIV Infections - etiology; HIV Infections - prevention & control; Human viral diseases; Humans; Infectious diseases; Internal Medicine; Male; Medical sciences; Prevention and actions; Preventive Health Services - organization & administration; Program Evaluation; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk; Sentinel Surveillance; Socioeconomic Factors; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Infection; Human; Medicine; Prevention; Immunopathology; Viral disease; AIDS; Structural analysis approach; Immune deficiency
• ISSN: 0140-6736; 1474-547X; 1474-547X
• DOI: 10.1016/S0140-6736(08)60887-9

Recognition that social, economic, political, and environmental factors directly affect HIV risk and vulnerability has stimulated interest in structural approaches to HIV prevention. Progress in the use of structural approaches has been limited for several reasons: absence of a clear definition; lack of operational guidance; and limited data on the effectiveness of structural approaches to the reduction of HIV incidence. In this paper we build on evidence and experience to address these gaps. We begin by defining structural factors and approaches. We describe the available evidence on their effectiveness and discuss methodological challenges to the assessment of these often complex efforts to reduce HIV risk and vulnerability. We identify core principles for implementing this kind of work. We also provide recommendations for ensuring the integration of structural approaches as part of combined prevention strategies.