Trapped in the prison of the proximate: structural HIV/AIDS prevention in southern Africa

Abstract

There is now agreement in HIV/AIDS prevention that biomedical and behavioural interventions do not sufficiently address the structural causes of the epidemic, but structural prevention is understood in different ways. The social drivers approach models pathways that link structural constraints to individuals at risk and then devises intervention to affect these pathways. An alternative political economy approach that begins with the bio-social whole provides a better basis for understanding the structural causes of HIV/AIDS. It demands that HIV/AIDS prevention in southern Africa should not be a set of discrete technical interventions but a sustained political as well as scientific project.

[Piégé dans la prison de l’approximatif : la prévention structurelle du VIH/SIDA en Afrique australe.] Il existe maintenant un consensus en matière de prévention du VIH : les interventions biomédicales et comportementales ne traitent pas assez les causes structurelles de l’épidémie, mais la prévention structurelle peut être comprise de différentes manières. L’approche des facteurs sociaux modélise des relations qui lient des contraintes structurelles aux individus à risque et conçoit des interventions qui influent sur ces relations. Une approche alternative de l’économie politique qui prend en compte l’ensemble biologique et social fournit une meilleure base pour la compréhension des causes structurelles du VIH/SIDA. Elle nécessite une prévention du VIH/SIDA en Afrique australe qui ne soit pas un ensemble d’interventions techniques discrètes mais un projet politique et scientifique durable.

Keywords:

• HIV/AIDS prevention
• southern Africa
• political economy

Mots-clés:

• prévention du VIH/SIDA
• Afrique australe
• économie politique

Note on contributor

Bridget O'Laughlin began as an anthropologist but moved towards development studies with her work in the Centre of African Studies and in the Economics Faculty at Eduardo Mondlane University in Maputo from 1979 to 1992. She subsequently worked in the population and development, rural development and methodology programmes at the Institute of Social Studies in the Hague, from which she is now retired. Her current research is on rural labour and rural health in Mozambique. She is a research associate of the Institute of Economic and Social Studies in Maputo.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. On the relation of the choice of interventions to neoliberalism, see Johnston on conditional cash transfers and MacPherson, Sadalaki, Nyongopa, et al. on microfinance, both in this issue.

2. This section relies on research in Xinavane carried out in 2012 by the Institute of Economic and Social Studies (Maputo). See O'Laughlin and Ibraimo 2013.