HIV Prevention 4 Structural approaches to HIV prevention

Recognition that social, economic, political, and environmental factors directly aff ect HIV risk and vulnerability has stimulated interest in structural approaches to HIV prevention. Progress in the use of structural approaches has been limited for several reasons: absence of a clear defi nition; lack of operational guidance; and limited data on the eff ectiveness of structural approaches to the reduction of HIV incidence. In this paper we build on evidence and experience to address these gaps. We begin by defi ning structural factors and approaches. We describe the available evidence on their eff ectiveness and discuss methodological challenges to the assessment of these often complex eff orts to reduce HIV risk and vulnerability. We identify core principles for implementing this kind of work. We also provide recommendations for ensuring the integration of structural approaches as part of combined prevention strategies.