Structural approaches to HIV prevention

Lancet. 2008 Aug 30;372(9640):764-75. doi: 10.1016/S0140-6736(08)60887-9. Epub 2008 Aug 5.


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.

Publication types

  • Review

MeSH terms

  • Behavior Therapy / methods*
  • Community Health Services / organization & administration
  • Community Health Services / trends
  • Condoms / statistics & numerical data*
  • Female
  • HIV Infections / etiology
  • HIV Infections / prevention & control*
  • Humans
  • Male
  • Preventive Health Services / organization & administration*
  • Program Evaluation
  • Risk
  • Sentinel Surveillance
  • Socioeconomic Factors