HIV prevention: Towards a “structural-plus” approach


Lack of integration and coordination between HIV prevention programmes and developmental programmes explain why many countries have not been able to halt the epidemic, and others still have unacceptably high prevalence. A framework is presented here with supporting evidence to argue that existing structural interventions may be unsustainable in the long run because they do not address core developmental issues or the “structural plus factors”. This problem emanates from the almost total administrative and intellectual disconnect between policies that address development issues and those that address HIV prevention. Usual prevention packages may result only in short term benefits. To get the most out of limited global resources on prevention, it is critical that planners recognize and understand that parallel policies for AIDS prevention and development are not going to be cost-effective and sustainable, and the only option is to approach prevention as well as development in an integrated manner.

Share and Cite:

Gupta, I. , Joe, W. and Rudra, S. (2013) HIV prevention: Towards a “structural-plus” approach. Health, 5, 102-108. doi: 10.4236/health.2013.51014.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] UNAIDS (2011). UNAIDS World AIDS Day Report.
[2] UNAIDS (2008) A Framework for Classifying HIV-prevention interventions. UNAIDS, Gene-va.
[3] Wilson, D. and Halperin, D.T. (2008) Know your epidemic, know your response: A useful approach, if we get it right. The Lancet, 372, 423-426. doi:10.1016/S0140-6736(08)60883-1
[4] Makinwa, B. and O’Grady, M., Eds. (2001). Best practices in HIV/AIDS prevention collection. FHI/UNAIDS, Geneva.
[5] Padian, N.S., Buve, A., Balkus, J. and Serwadda Jr., D.W.C. (2008) Biomedical interventions to prevent HIV infection: Evidence, challenges, and way forward. The Lancet, 372, 585-599. doi:10.1016/S0140-6736(08)60885-5
[6] Galárraga, O., Colchero, M.A., Wamai, R.G. and Bertozzi, S.M. (2009) HIV prevention cost-effectiveness: A systematic review. BMC Public Health—BioMed Central, 9, S1-S15.
[7] Coates, T.J., Richter, L. and Caceres, C. (2008) Behavioural strategies to reduce HIV transmission: How to make them work better. The Lancet, 372, 669-684. doi:10.1016/S0140-6736(08)60886-7
[8] Ross, D., Dick, B. and Ferguson, J., Eds., (2006) Preventing HIV/AIDS in young people: A systematic review of the evidence from developing countries. WHO Technical Report Series No. 938, World Health Organization, Geneva.
[9] Gupta, G.R., Parkhurst, J.O., Ogden, J.A., Aggleton, P. and Mahal, A. (2008) Structural approaches to HIV prevention. The Lancet, 372, 764-775. doi:10.1016/S0140-6736(08)60887-9
[10] Campbell, C. and Williams, B. (1999) Beyond the biomedical and behavioural: Towards an integrated approach to HIV prevention in the Southern African mining industry. Social Science & Medicine, 48, 1625-1639. doi:10.1016/S0277-9536(98)00449-3
[11] Sweat, M.D. and Denison, J.A. (1995) Reducing HIV incidence in developing countries with structural and environmental interventions. AIDS, 9, S251-S257.
[12] Philipson, T.J. and Posner, R.A. (1993) Private choices and public health: The AIDS epidemic in an economic perspective. Harvard University Press, Cambridge.
[13] Gertler, P., Shah, M. and Bertozzi, S.M. (2005) Risky business: The market for unprotected commercial sex. Journal of Political Economy, 113, 518-550. doi:10.1086/429700
[14] Rao, V., Gupta, I., Lokshin, M. and Jana, S. (2003) Sex workers and the cost of safe sex: The compensating differential for condom use among Calcutta prosti-tutes. Journal of Development Economics, 71, 585-603. doi:10.1016/S0304-3878(03)00025-7
[15] Balnkenship, K.M., Bray, S.J. and Merson, M.H. (2000) Structural interventions in public health. AIDS, 14, S11-S21. doi:10.1097/00002030-200006001-00003
[16] Merson, M.H., O’malley, J., Serwadda, D. and Apisuk, C. (2008) The history and challenge of HIV prevention. The Lancet, 372, 475-488. doi:10.1016/S0140-6736(08)60884-3
[17] Sumartojo, E., Doll, L., Holtgrave, D., Gayle, H. and Merson, M. (2000) Enriching the mix: Incorporating structural factors into HIV prevention. AIDS, 14, S1-S2. doi:10.1097/00002030-200006001-00001
[18] David, A.C. and Li, C.A. (2010) Exploring the links between HIV/AIDS, social capital and development. Journal of International Development, 22, 941-961. doi:10.1002/jid.1707
[19] Parkhurst, J.O. (2010) Understanding the correlations between wealth, poverty and human immunodeficiency virus infection in African countries. Bulletin of the World Health Organization, 88, 519-526. doi:10.2471/BLT.09.070185
[20] Edlund, L. and Korn, E. (2002) A theory of prostitution. Journal of Political Economy, 110, 181-214. doi:10.1086/324390
[21] Gupta, I., Trivedi, M. and Guin, P. (2008) Understanding HIV & development: An analysis from Bellary district in Karnataka, India. UNDP, New Delhi.
[22] Piot, P., Kazatchkine, M., Dybul, M. and Lob-Levyt, J. (2009) AIDS: Lessons learnt and myths dispelled. The Lancet, 374, 260-263. doi:10.1016/S0140-6736(09)60321-4
[23] Gilbert, L. and Walker, L. (2002) Treading the path of least resistance: HIV/AIDS and social inequalities? ??a South African case study. Social Science & Medicine, 54, 1093-1110. doi:10.1016/S0277-9536(01)00083-1
[24] Greener, R. and Sarkar, S. (2010) Risk and vulnerability: Do socioeconomic factors influence the risk of acquiring HIV in Asia? AIDS, 24, S3-S11. doi:10.1097/01.aids.0000390084.37812.30
[25] Kim, J., Pronyk, P., Barnett, T. and Watts, C. (2008) Exploring the role of economic empowerment in HIV prevention. AIDS, 22, S57-S71. doi:10.1097/01.aids.0000341777.78876.40
[26] Decosas, J. (1996) HIV and development. AIDS, 10, S69- S74.
[27] Soskolne, V. and Shtarkshall, R.A. (2002) Migration and HIV prevention programmes: Linking structural factors, culture, and individual behaviour???an Israeli experience. Social Science & Medicine, 55, 1297-1307. doi:10.1016/S0277-9536(01)00282-9
[28] Lurie, M.N., Williams, B.G., Zuma, K., Mkaya-Mwam-buri, D., Garnett, G.P., Sturm, A.W., Sweat, M.D., Gittel- sohn, J. and Karim, S.S.A. (2003) The impact of migration on HIV-1 transmission in South Africa: A study of migrant and nonmigrant men and their partners. Sexually Transmitted Diseases, 30, 149-156. doi:10.1097/00007435-200302000-00011
[29] Crush, J., Williams, B., Gouws, E. and Lurie, M. (2005) Migration and HIV/AIDS in South Africa. Development Southern Africa, 22, 293-318. doi:10.1080/03768350500253153
[30] Over M. (1997) The effect of societal variables on urban rates of HIV infections in developing countries. In: Ainsworth, M., Fransen, L. and Over, M., Eds., Confronting AIDS: Evidence from the Developing World, European Commission, Brussels, 39-51.
[31] Mahal, A. (2001) The human development roots of HIV and implications for policy: A cross country analysis. Journal of Health and Population in Developing Countries, 4, 43-60.
[32] Hogan, D.R., Baltussen, R., Hayashi, C., Lauer, J.A. and Salomon, J.A. (2005) Cost effectiveness analysis of strategies to combat HIV/AIDS in developing countries. British Medical Journal, 331, 1431-1437. doi:10.1136/bmj.38643.368692.68
[33] O’leary, A. and Martins, P. (2000) Structural factors affecting women’s HIV risk: A life-course example. AIDS, 14, S68-S72. doi:10.1097/00002030-200006001-00011
[34] Clark, R.C. and Vencatachellum, D. (2003) Economic development and HIV/AIDS prevalence. Economic Development and HIV/AIDS Prevalence Scientific Series. Centre Interuniversitaire de Recherche en Analyse Des Organisations, Montreal.
[35] Green, E., Halperin, D., Nantulya, V. and Hogle, J. (2006) Uganda’s HIV prevention success: The role of sexual behavior change and the national response. AIDS and Behavior, 10, 335-346. doi:10.1007/s10461-006-9073-y
[36] Dzenovska, D., Rasheed, N. and Sandkj?r, B. (2005) HIV/AIDS and human development: Thematic guidance note. NHDR Occasional Paper 4. National Human Development Reports Unit, Human Development Report Office, UNDP.
[37] UNAIDS (2010) Global Report: UNAIDS report on the global AIDS epidemic. UNAIDS, Geneva.
[38] UNDP (2010) Human Development Report 2010.
[39] Wagstaff, A, Paci, P. and van Doorslaer, E. (1991) On the measurement of inequalities in health. Social Science and Medicine, 33, 545-557. doi:10.1016/0277-9536(91)90212-U
[40] Rau, B. and Collins, J. (2000) AIDS in the context of development. Joint United Nations Programme on HIV/ AIDS, UNRISD.
[41] Avert (2012) HIV and AIDS in Russia, Eastern Europe and Central Asia.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.