Structural Approaches to HIV Prevention

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Structural Approaches to HIV Prevention

• Geeta Rao Gupta, Justin Parkhurst, Jessica Ogden,
  Peter Aggleton
• Ajay Mahal

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CONTEXT MATTERS
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Structural Approaches

• Aim to change the conditions in which people live
  
• Can be implemented as single policies or programs
  
• Or multiple structural actions implemented
  simultaneously, or
• Community processes that catalyze social and
  political change

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Structural Factors

• Operate at different levels and different
  distances from risk/vulnerability
• Link to risk and vulnerability in different ways
• The relationship between a structural factor and
  HIV outcomes can be complex

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Gender Inequality
Unprotected sex
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Developing a Structural Approach

• Know your epidemic (and identify your causal
  pathways)
• Nature of causal pathways
• Where (at what level) to act and
• Who (which sector, set of actors) should act
• Might need to act at various levels at once, in
  combination and/or in sequence

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Challenges for Evaluation

• When action takes place up-stream, attribution
  becomes difficult
• Structural approaches can generate spontaneous
  activities not covered at baseline
• Comparison difficult due to lack of ethnographic
  and process data