Structural Interventions: An Overview of Structural Approaches to HIV Prevention

This resource provides information about, and links to, research and tools for those seeking to find what works in HIV prevention.

The introductory section explains that structural approaches reduce an individual's HIV-related vulnerability by creating the conditions in which people can adopt safer behaviours. Strategies for categorising structural approaches detailed here include: (i) Social change: These approaches focus on factors affecting multiple groups (e.g., a region or country as a whole), such as legal reform, stigma reduction, and efforts to cultivate strong leadership on AIDS; (ii) Change within specific groups: These approaches address social structures that create vulnerability among specific populations, such as men who have sex with men, mine workers, young women, or economically poor women. Examples include efforts to organise and mobilise sex workers, and interventions to change harmful male norms; and (iii) Harm reduction or health-seeking behaviour change: These approaches work to make harm-reduction technologies available to those in need and to change rules, services, and attitudes about these technologies. "The most effective structural approaches will use a combination of strategies that are tailored to a given social, political, economic, and epidemic context." "Quantifying the effectiveness of structural intervention programs can be difficult for several reasons: there is no direct, one-to-one relationship between structural interventions and HIV incidence; structural interventions are not generally amenable to randomization; and causal pathways from intervention to AIDS outcome are usually indirect and complex. It will be necessary to develop evaluation methodologies not classically used within public health, and to engage more social scientists in program design and evaluation."

Following the introductory material, the resource includes lists of resources associated with: (i) research providing the evidence base that supports the prevention approach (e.g., "A Structural Model of Health Behavior: A Pragmatic Approach to Explain and Influence Health Behaviors at the Population Level"); (ii) summaries of promising interventions (e.g., "Communities Confront HIV Stigma in Vietnam: Participatory Interventions to Reduce HIV-related Stigma in Two Provinces"); (iii) programme materials, including tools, curricula, and models (e.g., "Guidelines for Inclusion of Individuals with Disability in HIV/AIDS Outreach Efforts"); and (iv) additional materials and websites (e.g., Men As Partners Program website).