Structural forces – legal, economic and social factors – shape the HIV risk of individuals and populations. These factors interact in many different ways to affect behaviours such as choice of sexual partner and use of condoms. Certain structural factors may also undermine treatment and prevention efforts.
STRIVE investigates the causal pathways connecting these key structural drivers of the HIV epidemic:
- Gender inequality and gender roles encourage male promiscuity, make women vulnerable to violence and restrict their ability to discuss or negotiate sex.
- Limited livelihood opportunities, along with migration, shape patterns of sexual mixing, deplete hope and hinder HIV prevention and treatment efforts.
- Stigma and criminalisation prevent people from getting HIV tested and hinder the efforts of MSM, sex workers and other marginalised groups to avoid HIV and/or access services;
- Unrestricted alcohol availability and drinking norms exacerbate sexual risk-taking and gender-based violence.
STRIVE focuses on these drivers because:
- empirical evidence strongly links each factor with HIV infection;
- consortium members are involved in ongoing interventions targeting these key drivers and also in standard HIV interventions to which structural components can be added; and
- progress on these issues will yield a host of wider development benefits.
By combining standard HIV interventions with components to address structural drivers, STRIVE will be able to assess the value of this dual approach in multiple settings over time. This research is designed to provide evidence on the potential synergies and economies of better integrating social welfare, health and development policy.
Some general STRIVE materials explaining the concept of a structural approach to HIV:
- Interview with STRIVE CEO Dr Lori Heise on the upstream factors that shape HIV risk
- Introduction to STRIVE from Research Director Prof Charlotte Watts from World AIDS Day 2012
- STRIVE infographic: Tackling the structural drivers of HIV
Causal pathways connecting structural drivers
Punitive laws, gender inequality, violence against women and other human rights violations continue to undermine national AIDS responses.UN Secretary-General Ban Ki-moon