Addressing social drivers of HIV/AIDS for the long-term response: Conceptual and methodological considerations

Abstract

A key component of the shift from an emergency to a long-term response to AIDS is a change in focus from HIV prevention interventions focused on individuals to a comprehensive strategy in which social/structural approaches are core elements. Such approaches aim to modify social conditions by addressing key drivers of HIV vulnerability that affect the ability of individuals to protect themselves and others from HIV. The development and implementation of evidence-based social/structural interventions have been hampered by both scientific and political obstacles that have not been fully explored or redressed. This paper provides a framework, examples, and some guidance for how to conceptualise, operationalise, measure, and evaluate complex social/structural approaches to HIV prevention to help situate them more concretely in a long-term strategy to end AIDS.

Some considerations concerning the challenge of incorporating social variables into epidemiological models of infectious disease transmission

“…The former term has been used to refer to correlational associations between an epidemiologically significant variable (for example acquisition of a disease) and another variable (exposure to polluted water) which, while strongly suspected to be associated with disease acquisition, may or may not be causal in its association with that variable. The latter term, driver, has in recent years been frequently used to describe the ways in which micro (individual) and macro (institutional, systemic) elements affect the risk of infection (Gupta 2008;Auerbach 2011;Parkhurst 2013). Although we have sketched a range of possible emergent property variables in the preceding, for the moment we are centrally focused on a test variable representing this general type of emergent property variable.…”

Indivíduos, estruturas e riscos: panorâmica da prevenção primária do HIV em Portugal

“…Ainda que sejam enunciados gerais nem sempre de fácil concretização, essas abordagens vão no sentido do que aqui designo como prevenção de banda larga: conjunto diversificado e concertado de procedimentos que, simultaneamente e de forma transversal e multidisciplinar, atuem em diferentes escalas psicossociais (subjetiva, relacional, contextual e estrutural) e temporais (curto, médio e longo prazo), visando a uma intervenção de grande amplitude, integrada e sinergética, que previna as disposições micro, meso e macro geradoras de riscos epidê-micos. Para tal, como é destacado por Auerbach et al 14 Os obstáculos colocados ao desenvolvimento de programas de prevenção com enfoque estrutural são muitos. Podem distinguir-se quatro tipos de desafios no entender de Auerbach 15 : (i) aspetos de natureza conceitual e metodológica relacionados, sobretudo, com as dificuldades em apreender, quantificar, padronizar, intervir e avaliar efeitos no âmbito das grandes condicionantes sociais da epidemia do HIV/AIDS; (ii) a morosidade das mudanças sociais e a produção de resultados apenas a médio e longo prazos, o que pode gerar alguma frustração junto de decisores políticos e de profissionais de saúde; (iii) a possibilidade de falta de apoio público a decisões políticas e intervenções que visam a melhorar as condições sociais de grupos fortemente marginalizados, como os usuários de drogas injetáveis (UDI), as pessoas que exercem a prostituição e os detidos; (iv) o elevado custo financeiro que, quase sempre, está associado às estratégias estruturais de minimização dos riscos de infecção por HIV, sendo que este custo será sempre muito maior quando o sistema de prevenção não funciona de forma eficaz.…”

Redesigning the AIDS response for long-term impact

“…However, there is little empirical evidence that structural interventions can actually reduce HIV transmission and so more research is needed. 35 One of the key recommendations of the aids2031 Social Drivers Working Group is that "there is a package of reforms that constitute a minimum legal standard for facilitating an enabling environment for AIDS resilience". 36 These include the decriminalization of: HIV status, transmission and exposure; same-sex relationships/ sexual practices; and harm-reduction approaches for prevention of AIDS among injecting drug users.…”