Moving beyond behaviour: Advancing HIV risk prevention epistemologies and interventions (A report on the state of the literature)

Abstract

This paper is based on an extensive literature review of academic, policy and ‘grey’ literatures on the intersections of culture and the global HIV/AIDS pandemic commissioned by UNESCO. It highlights that the review exposed a dominant conceptual perspective that poorly captures structures of vulnerability, particularly structures that expose entire populations to risk in relatively uniform ways. Stemming from this, the review revealed a series of specific topical areas in need of further research including masculinities, transactional sex, infrastructural deficits in health and education, fragile states and global governance. For each of these topical areas the authors demonstrate the relationship to the conceptual limitation, summarise relevant research in this area, and provide evidence of applicability to public health interventions. In pursuit of more effective interventions, this paper draws attention to some of the conceptual limitations of current approaches to understanding the pandemic, and calls for interventions that move beyond individual behaviours to address structures that shape individual behaviour and make entire populations more vulnerable to HIV.

Keywords:

• acquired immunodeficiency syndrome
• culture
• gender
• socio-economic factors
• organisation and administration
• legislation and jurisprudence

Acknowledgements

We would like to thank Vinh-Kim Nguyen and Jennifer Klot for their invaluable input and support. This work was supported, in part, through a grant from UNESCO. Additional support was provided by New York University, the Social Science Research Council and the Canadian Institutes of Health Research.