Structural Interventions for HIV Prevention in the United States

Abstract

Background Structural interventions change the environment in which people act, in order to influence their health behaviors. Most structural interventions research for HIV infection has focused on developing countries, with the United States receiving substantially less attention. This article identifies some social determinants of HIV vulnerability in the United States and structural interventions to address them. Methods Review of the medical, public health, and social science literature. Results Evidence supports widespread implementation of a number of structural interventions in the United States clearly proximate to HIV, including comprehensive sex education, universal condom availability, expanded syringe access for drug users, health care coverage, and stable housing. Sociological plausibility supports evaluation and implementation of other interventions that target social determinants more distal but of relevance to HIV, such as initiatives to eliminate racial and ethnic disparities in criminal sentencing, to promote early childhood education, and to decrease poverty. Conclusion Structural interventions that address social determinants of HIV infection may be among the most cost effective methods of preventing HIV infection in the United States over the long term.

Socioeconomic Disadvantage as a Social Determinant of Teen Childbearing in the U.S.

“…Growing research on structural and multilevel interventions for human immunodeficiency virus prevention, while inconclusive, shows promise and should provide important lessons for researchers studying teen pregnancy and birth. 42 The field of public health cannot take on this challenge single-handedly. Effective collaborations with other sectors (e.g., education and housing) are vital to ensure that the underlying social determinants of sexual health are addressed.…”

Fatores associados ao baixo conhecimento sobre HIV/AIDS entre homens que fazem sexo com homens no Brasil

“…Melhor escolaridade estimula a demanda por conhecimentos específicos sobre a doença, e facilita o entendimento dos riscos de contágio quando as informações são providas por meio da mídia, familiares, ONGs e serviços. Adimora & Auerbach 29 indicam que as intervenções estruturais que abordam os determinantes sociais da infecção pelo HIV podem estar entre os métodos mais eficientes de prevenção desta infecção, e que as pesquisas devem traçar com clareza os caminhos entre os determinantes sociais e a infecção pelo HIV e desenvolver novas metodologias que possam testar estas intervenções. Na dimensão de vulnerabilidade individual, os resultados apontam para um baixo conhecimento entre HSH jovens com idades abaixo de 25 anos.…”

Examining the role of vocational rehabilitation on access to care and public health outcomes for people living with HIV/AIDS

“…This inclusion of employment and vocational services in the National HIV/AIDS Strategy reflects an increased interest in examining structural factors (such as reducing poverty) on HIV health and prevention outcomes [2] as well as the increased need for these services among people living with HIV/AIDS.…”