Reducing HIV incidence in developing countries with structural and environmental interventions.

Abstract

The AIDS epidemic as a health problem is exacerbated by the risk behavior of people. As the worldwide AIDS pandemic matures and changes so too must the approach to prevention. AIDS prevention programs need to incorporate more than just individualistic psychological approaches to risk reduction. It is important to learn more about the effect of social cultural political and economic factors on HIV risk behavior and to develop creative culturally appropriate and community-sponsored prevention programs that make substantive changes on multiple levels. In the article the use of structural and environmental interventions for HIV risk reduction is examined by developing a theoretical approach to levels of causation in HIV incidence that goes beyond the individual perspective. A typology of four levels of causation has been identified comprising superstructural structural environmental and individual levels. On the other hand the structural and environmental interventions that have been shown to promote the incidence of HIV is examined namely economic underdevelopment and poverty migration urbanization and family disruption. Meanwhile possible structural and environmental interventions that may prevent AIDS are suggested. Finally a research agenda is presented for further investigation of the topic.