Structural factors in HIV prevention: concepts, examples, and implications for research

TLDR

HIV‑prevention behavior is shaped by environmental and individual factors, with structural factors defined as barriers or facilitators linked to economic, social, policy, and organizational aspects of the environment. The study aims to provide frameworks that help researchers and health officials identify key areas for structural research and programming. The authors present a CDC‑developed framework that defines structural barriers and facilitators for HIV prevention across economic, policy, societal, and organizational domains. Structural interventions have shown promise in increasing HIV prevention both in the United States and internationally, and similar successes in other public health areas suggest their broader potential, though challenges in evaluation remain; nevertheless, the authors urge continued pursuit of structural approaches.

Abstract

Introduction: HIV-prevention behavior is affected by the environment as well as by characteristics of individuals at risk. HIV-related structural factors are defined as barriers to, or facilitators of, an individual's HIV prevention behaviors; they may relate to economic, social, policy, organizational or other aspects of the environment. Impact of structural interventions: A relatively small number of intervention studies demonstrates the potential of structural interventions to increase HIV prevention in the United States and internationally. The promise of structural interventions has also been shown in studies of interventions to prevent disease or promote public health in areas other than HIV. Framework of structural factors: Frameworks help define and exemplify structural barriers and facilitators for HIV prevention. One framework developed at Centers for Disease Control and Prevention gives examples of structural facilitators in terms of the economic resources, policy supports, societal attitudes, and organizational structures and functions associated with governments, service organizations, businesses, workforce organizations, faith communities, justice systems, media organizations, educational systems, and healthcare systems. Frameworks should assist researchers and health officials to identify important areas for structural research and programming. Conclusions: A structural approach is timely and innovative. Despite limitations, including the challenge of a new perspective on prevention and the difficulty of evaluating their effects, researchers and public health officials are urged to pursue structural interventions to prevent HIV.