Structural interventions to encourage primary HIV prevention among people living with HIV

Abstract

This analysis focuses on primary prevention for people living with HIV and the importance of actively involving HIV-infected people in developing prevention strategies. Structural-level or policy interventions--as opposed to behavioral or psychological interventions--help shape the world in which HIV-infected people live. Thus, we assess potential policy-level interventions that may serve either as a barrier to or a facilitator of primary HIV prevention from the perspective of the people living with HIV. Among potential barriers, we discuss criminalization of nondisclosure in specific sexual situations, laws limiting travel and immigration, name-based HIV reporting and mandatory partner notification. Under potential facilitators, we discuss confidentiality laws, antidiscrimination protections, expansion of HIV primary care, and primary prevention programs designed to actively involve infected people. Ultimately, whether any given policy is a 'barrier' or 'facilitator' of primary HIV prevention is an empirical question, dependent on the acceptability of an intervention to those already infected and those at risk, thus policy research evaluating the impact of structural factors on people living with HIV is encouraged.

Early Warning Indicators for First-Line Virologic Failure Independent of Adherence Measures in a South African Urban Clinic

“…Access to clinic refills as measured by the MPR is not always a reliable indicator of adherence, as it is not necessarily indicating ingested pills and individuals can obtain ARVs through other unmeasured sources. Although socioeconomic barriers have been welldescribed as leading to treatment interruptions, missed visits, and poor adherence, 8,72,73 these factors appear to be overshadowed by psychosocial and clinical factors in our study, reinforcing the importance of a comprehensive approach to assessing determinants of health. Socioeconomic and institutional barriers can often be more readily addressed with discrete interventions (transportation and food assistance or improving the clinic environment), 9 whereas psychosocial barriers can be more challenging to address.…”

HIV and Housing Assistance in Four U.S. Cities: Variations in Local Experience

“…Government policies and programs can be incorporated into ecological models as 'structural level' factors that may influence health and behavior. Structural interventions are receiving increasing attention in the context of the HIV epidemic (Shriver, Everett, & Morin, 2000, Sumartojo, Doll, Holtgrave, Gayle, & Merson, 2000, Sweat & Denison, 1995.…”

Why Housing?

“…Income and race, the two factors most consistently associated with differential health are also the factors that determine access to good housing in good neighborhoods and the variety of threats or enhancements of well-being provided by different residential contexts (Acevedo-Garcia et al, 2004;Saegert & Evans, 2003). Housing warrants more focused attention as a structural factor which directly or indirectly affects an individual's ability to avoid exposure to HIV, or for HIV positive individuals to avail of health promoting and risk reducing resources (Blakenship, Friedman, Dworkin, & Mantell, 2006;Shriver, Everett, & Morin, 2000;Sumartojo, 2000).…”