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.

Keywords:

• HIV
• social determinants
• structural interventions
• global response
• research methods

Acknowledgements

We thank GeetaRao Gupta and William Fisher for their guidance in developing this paper in its earliest iteration and the members of the aids2031 Social Drivers Working Group for their additional input; Alan Whiteside and anonymous reviewers for their thoughtful suggestions about the paper; Jessica Ogden for contributing the sex worker example to our Figure 1; and Reilly O'Neal for her excellent assistance with copyediting the document.