Pub Date : 2018-11-26DOI: 10.1093/OSO/9780190675486.003.0011
R. Parker, Jonathan Garcia, M. Muñoz-Laboy, L. Murray, F. Seffner
This chapter documents the ways in which the Brazilian focus on community mobilization and empowerment has succeeded in implementing timely and effective HIV prevention programs in key affected communities such as sex workers and gay, bisexual, and other men who have sex with men. Further, the chapter analyzes the ways in which this strategy made it possible to address many of the structural drivers of HIV in these communities. Of great importance, however, it also highlights the extent to which addressing these structural forces depended on a favorable political context capable of supporting and nurturing such approaches. The subsequent “shift” of focus in terms of HIV prevention in Brazil is then examined to show how the broader political ecology of the country unfavorably changed what had been an effective initial response to ending AIDS in Brazil.
{"title":"Community Mobilization as an HIV Prevention Strategy","authors":"R. Parker, Jonathan Garcia, M. Muñoz-Laboy, L. Murray, F. Seffner","doi":"10.1093/OSO/9780190675486.003.0011","DOIUrl":"https://doi.org/10.1093/OSO/9780190675486.003.0011","url":null,"abstract":"This chapter documents the ways in which the Brazilian focus on community mobilization and empowerment has succeeded in implementing timely and effective HIV prevention programs in key affected communities such as sex workers and gay, bisexual, and other men who have sex with men. Further, the chapter analyzes the ways in which this strategy made it possible to address many of the structural drivers of HIV in these communities. Of great importance, however, it also highlights the extent to which addressing these structural forces depended on a favorable political context capable of supporting and nurturing such approaches. The subsequent “shift” of focus in terms of HIV prevention in Brazil is then examined to show how the broader political ecology of the country unfavorably changed what had been an effective initial response to ending AIDS in Brazil.","PeriodicalId":202438,"journal":{"name":"Structural Interventions for HIV Prevention","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129463247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-26DOI: 10.1093/oso/9780190675486.003.0010
W. Nutland
There remains a lack of consensus about the extent to which pre-exposure prophylaxis (PrEP) contributed to the recent dramatic and stunning declines in HIV incidence occurring in the United Kingdom. This chapter describes the potential role of PrEP in this decline and offers insights into how this occurred despite a lack of formal, government-sponsored support for PrEP. Further, the chapter describes the development of a new PrEP movement in England as well as contributing factors, such as the leadership of a new wave of HIV activists, access to global generic markets, innovative supply chains, and the use of social media and the Internet. The “U-turn” and subsequent court cases are also described.
{"title":"Getting to 40!","authors":"W. Nutland","doi":"10.1093/oso/9780190675486.003.0010","DOIUrl":"https://doi.org/10.1093/oso/9780190675486.003.0010","url":null,"abstract":"There remains a lack of consensus about the extent to which pre-exposure prophylaxis (PrEP) contributed to the recent dramatic and stunning declines in HIV incidence occurring in the United Kingdom. This chapter describes the potential role of PrEP in this decline and offers insights into how this occurred despite a lack of formal, government-sponsored support for PrEP. Further, the chapter describes the development of a new PrEP movement in England as well as contributing factors, such as the leadership of a new wave of HIV activists, access to global generic markets, innovative supply chains, and the use of social media and the Internet. The “U-turn” and subsequent court cases are also described.","PeriodicalId":202438,"journal":{"name":"Structural Interventions for HIV Prevention","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129966890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-26DOI: 10.1093/OSO/9780190675486.003.0012
B. Hensen, S. Dringus, R. Eakle, M. Remme, J. Hargreaves
Evaluating structural interventions to understand whether they are effective, for whom, and in what context is critical to determining whether, where, and how to deliver structural interventions at scale. This chapter provides a comprehensive evaluation framework comprising three main components: impact of the intervention, process evaluation, and an economic evaluation. Featured within this chapter is the point that structural-level interventions are amenable to evaluation using adaptation of the gold-standard randomized controlled trial design. Where randomization is not feasible, however, the chapter provides alternative designs to evaluate effectiveness, including those that use the stepped-wedge cluster randomized trial, interrupted time series, and nonequivalent comparison group. Four types of economic evaluation techniques are also described.
{"title":"Evaluating Structural Interventions","authors":"B. Hensen, S. Dringus, R. Eakle, M. Remme, J. Hargreaves","doi":"10.1093/OSO/9780190675486.003.0012","DOIUrl":"https://doi.org/10.1093/OSO/9780190675486.003.0012","url":null,"abstract":"Evaluating structural interventions to understand whether they are effective, for whom, and in what context is critical to determining whether, where, and how to deliver structural interventions at scale. This chapter provides a comprehensive evaluation framework comprising three main components: impact of the intervention, process evaluation, and an economic evaluation. Featured within this chapter is the point that structural-level interventions are amenable to evaluation using adaptation of the gold-standard randomized controlled trial design. Where randomization is not feasible, however, the chapter provides alternative designs to evaluate effectiveness, including those that use the stepped-wedge cluster randomized trial, interrupted time series, and nonequivalent comparison group. Four types of economic evaluation techniques are also described.","PeriodicalId":202438,"journal":{"name":"Structural Interventions for HIV Prevention","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132191546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-26DOI: 10.1093/OSO/9780190675486.003.0007
A. Mantsios, D. Kerrigan, J. Mbwambo, S. Likindikoki, C. Shembilu
This chapter examines different strategies for addressing the economic vulnerability that puts female sex workers (FSW) at increased risk of acquiring HIV. After presenting various theoretical approaches to economic interventions with FSW, the chapter provides examples of interventions employing different approaches. The focus is placed on interventions using a community empowerment approach. The authors argue that it is through this type of approach that FSW can confront their economic vulnerability at the community level, rather than through programs focused on increasing individual income alone. An applied example is provided by an in-depth look at community savings groups among FSW in Tanzania.
{"title":"Economic Strengthening Approaches with Female Sex Workers","authors":"A. Mantsios, D. Kerrigan, J. Mbwambo, S. Likindikoki, C. Shembilu","doi":"10.1093/OSO/9780190675486.003.0007","DOIUrl":"https://doi.org/10.1093/OSO/9780190675486.003.0007","url":null,"abstract":"This chapter examines different strategies for addressing the economic vulnerability that puts female sex workers (FSW) at increased risk of acquiring HIV. After presenting various theoretical approaches to economic interventions with FSW, the chapter provides examples of interventions employing different approaches. The focus is placed on interventions using a community empowerment approach. The authors argue that it is through this type of approach that FSW can confront their economic vulnerability at the community level, rather than through programs focused on increasing individual income alone. An applied example is provided by an in-depth look at community savings groups among FSW in Tanzania.","PeriodicalId":202438,"journal":{"name":"Structural Interventions for HIV Prevention","volume":"160 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114735625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-26DOI: 10.1093/oso/9780190675486.003.0009
R. Fullilove
Given the vast potential to intervene in prison settings, this chapter provides the background and a corresponding case study as to how structural-level approaches might be used to prevent HIV acquisition/transmission in prison settings. A peer-based model that empowers inmates to be the change agents is described. The chapter offers a compelling case that peer education programs created, managed, and administered by incarcerated persons have significant and often unrecognized potential. It begins with an overview of HIV in US prisons, followed by a description of peer education programs and HIV prevention and World AIDS Day in Prison using three correctional facilities as examples. Implications and conclusions close out the chapter.
{"title":"Structural-Level Approaches for HIV Prevention and Care in US Prisons","authors":"R. Fullilove","doi":"10.1093/oso/9780190675486.003.0009","DOIUrl":"https://doi.org/10.1093/oso/9780190675486.003.0009","url":null,"abstract":"Given the vast potential to intervene in prison settings, this chapter provides the background and a corresponding case study as to how structural-level approaches might be used to prevent HIV acquisition/transmission in prison settings. A peer-based model that empowers inmates to be the change agents is described. The chapter offers a compelling case that peer education programs created, managed, and administered by incarcerated persons have significant and often unrecognized potential. It begins with an overview of HIV in US prisons, followed by a description of peer education programs and HIV prevention and World AIDS Day in Prison using three correctional facilities as examples. Implications and conclusions close out the chapter.","PeriodicalId":202438,"journal":{"name":"Structural Interventions for HIV Prevention","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121678883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-26DOI: 10.1093/OSO/9780190675486.003.0003
Sarah Baird, T. Ahner-McHaffie, B. Ozler
This chapter provides insights into resolving the social issues that have led to the pre-existent disparity of young females are far more likely than young males to be infected by HIV. In this case, the structural-level problem is centered on inequitable access to education in sub-Saharan Africa. The chapter examines the impact of conditional and unconditional cash transfers on risk factors related to HIV among girls. After summarizing the existing evidence, the chapter provides a detailed description of two studies: the Schooling, Income and Health Risk study in Malawi and the Empowerment and Livelihood study in Uganda. A final section of the chapter gives recommendations for policy and future research.
{"title":"Can Interventions to Increase Schooling and Incomes Reduce HIV Incidence Among Young Women in Sub-Saharan Africa?","authors":"Sarah Baird, T. Ahner-McHaffie, B. Ozler","doi":"10.1093/OSO/9780190675486.003.0003","DOIUrl":"https://doi.org/10.1093/OSO/9780190675486.003.0003","url":null,"abstract":"This chapter provides insights into resolving the social issues that have led to the pre-existent disparity of young females are far more likely than young males to be infected by HIV. In this case, the structural-level problem is centered on inequitable access to education in sub-Saharan Africa. The chapter examines the impact of conditional and unconditional cash transfers on risk factors related to HIV among girls. After summarizing the existing evidence, the chapter provides a detailed description of two studies: the Schooling, Income and Health Risk study in Malawi and the Empowerment and Livelihood study in Uganda. A final section of the chapter gives recommendations for policy and future research.","PeriodicalId":202438,"journal":{"name":"Structural Interventions for HIV Prevention","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134001156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-26DOI: 10.1093/oso/9780190675486.003.0013
B. Hensen, S. Dringus, R. Eakle, M. Remme, J. Hargreaves
This chapter provides multiple insights into the theoretical basis of structural-level intervention approaches to the prevention and control of HIV/AIDS. Set within the context of social science theories applied to HIV/AIDS and the growing realization that behavioral theories are lacking in effect, the chapter suggests an expanded role of social science theory in the development of structural-level interventions. A case is presented that moving forward to prevent and control the pandemic will require improved theoretical frameworks for addressing persistent inequities. Topics covered include the emergence of “structural interventions” in HIV/AIDS and ways to move theoretically informed structural interventions. A theoretically informed agenda for a new generation of structural interventions is proposed.
{"title":"Enhancing Theory of Structural-Level Interventions for HIV Prevention and Care","authors":"B. Hensen, S. Dringus, R. Eakle, M. Remme, J. Hargreaves","doi":"10.1093/oso/9780190675486.003.0013","DOIUrl":"https://doi.org/10.1093/oso/9780190675486.003.0013","url":null,"abstract":"This chapter provides multiple insights into the theoretical basis of structural-level intervention approaches to the prevention and control of HIV/AIDS. Set within the context of social science theories applied to HIV/AIDS and the growing realization that behavioral theories are lacking in effect, the chapter suggests an expanded role of social science theory in the development of structural-level interventions. A case is presented that moving forward to prevent and control the pandemic will require improved theoretical frameworks for addressing persistent inequities. Topics covered include the emergence of “structural interventions” in HIV/AIDS and ways to move theoretically informed structural interventions. A theoretically informed agenda for a new generation of structural interventions is proposed.","PeriodicalId":202438,"journal":{"name":"Structural Interventions for HIV Prevention","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129319378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-26DOI: 10.1093/OSO/9780190675486.003.0014
R. Crosby, R. DiClemente, Jacqueline Sims
This chapter describes the AIDS pandemic as being intimately linked with inequitable social conditions. The case is made that these social inequities must be the primary “target” of HIV prevention efforts. The five pillar model is introduced and used as guide for illustrating the inherent value of structural-level interventions to the goal of ending AIDS. The chapter further makes the case that rectifying social inequities is the basis for going beyond the goal of ending AIDS and moving toward global health for all people. The chapter describes the social drivers of the pandemic, a prevention paradigm, and a proposed framework for structural-level interventions.
{"title":"Social Conditions and the AIDS Pandemic","authors":"R. Crosby, R. DiClemente, Jacqueline Sims","doi":"10.1093/OSO/9780190675486.003.0014","DOIUrl":"https://doi.org/10.1093/OSO/9780190675486.003.0014","url":null,"abstract":"This chapter describes the AIDS pandemic as being intimately linked with inequitable social conditions. The case is made that these social inequities must be the primary “target” of HIV prevention efforts. The five pillar model is introduced and used as guide for illustrating the inherent value of structural-level interventions to the goal of ending AIDS. The chapter further makes the case that rectifying social inequities is the basis for going beyond the goal of ending AIDS and moving toward global health for all people. The chapter describes the social drivers of the pandemic, a prevention paradigm, and a proposed framework for structural-level interventions.","PeriodicalId":202438,"journal":{"name":"Structural Interventions for HIV Prevention","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117171272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-26DOI: 10.1093/OSO/9780190675486.003.0001
R. DiClemente, R. Crosby, Jacqueline Sims
Beginning with the observation that AIDS has a tendency to invade subpopulations within a nation that are the most marginalized, this chapter provides case examples of the epidemic within five different nations. Specifically, the authors discuss Lesotho, the United Kingdom, Thailand, Ukraine, and India. The chapter characterizes the vast differences that exist across the national HIV epidemics that comprise the AIDS pandemic. The authors examine specific vulnerable populations, such as sex workers, intravenous drug users, transgendered people, and men who have sex with other men. They also discuss the role of social conditions and social norms, such as women’s rights, not only in the spread of but also the treatment of HIV.
{"title":"Global Burden of HIV/AIDS","authors":"R. DiClemente, R. Crosby, Jacqueline Sims","doi":"10.1093/OSO/9780190675486.003.0001","DOIUrl":"https://doi.org/10.1093/OSO/9780190675486.003.0001","url":null,"abstract":"Beginning with the observation that AIDS has a tendency to invade subpopulations within a nation that are the most marginalized, this chapter provides case examples of the epidemic within five different nations. Specifically, the authors discuss Lesotho, the United Kingdom, Thailand, Ukraine, and India. The chapter characterizes the vast differences that exist across the national HIV epidemics that comprise the AIDS pandemic. The authors examine specific vulnerable populations, such as sex workers, intravenous drug users, transgendered people, and men who have sex with other men. They also discuss the role of social conditions and social norms, such as women’s rights, not only in the spread of but also the treatment of HIV.","PeriodicalId":202438,"journal":{"name":"Structural Interventions for HIV Prevention","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121729836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-26DOI: 10.1093/OSO/9780190675486.003.0005
A. Aidala, M. Yomogida, J. Leigh
Populations with food and nutrition challenges are also those with highest rates of HIV infection. Rates of food insecurity are exceptionally high among people living with HIV. Although there have been advances in access to prevention, treatment, and care including nutrition support in resource-poor countries, recent studies continue to document prevalence of food insecurity among people living with HIV. This chapter contextualizes food insecurity as part of national HIV epidemics and provides a comprehensive treatment of possible solutions to the seemingly intractable and global problem. Topics covered include prevalence and predictors; bidirectional pathways linking food insecurity and HIV/AIDS; and responding to food insecurity and nutrition needs, including via a systems approach. It also includes practice examples.
{"title":"Food Insecurity and HIV/AIDS","authors":"A. Aidala, M. Yomogida, J. Leigh","doi":"10.1093/OSO/9780190675486.003.0005","DOIUrl":"https://doi.org/10.1093/OSO/9780190675486.003.0005","url":null,"abstract":"Populations with food and nutrition challenges are also those with highest rates of HIV infection. Rates of food insecurity are exceptionally high among people living with HIV. Although there have been advances in access to prevention, treatment, and care including nutrition support in resource-poor countries, recent studies continue to document prevalence of food insecurity among people living with HIV. This chapter contextualizes food insecurity as part of national HIV epidemics and provides a comprehensive treatment of possible solutions to the seemingly intractable and global problem. Topics covered include prevalence and predictors; bidirectional pathways linking food insecurity and HIV/AIDS; and responding to food insecurity and nutrition needs, including via a systems approach. It also includes practice examples.","PeriodicalId":202438,"journal":{"name":"Structural Interventions for HIV Prevention","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131777377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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