Structural interventions (SI) view health as a product of social context and promote health by altering this context. They contrast with views of health as a product of individual choice, behavior, or pathology. This paper presents results of ongoing research to develop a methodology for identifying and assessing SI and to apply this methodology to: 1) develop a comprehensive list of SI to reduce HIV incidence in drug users; and 2) identify priority areas from among these alternatives for CT. A key component of this methodology is the linking of cause to intervention strategy. The first step is to identify a starting point, which may include epidemiological pressure points, immediate risk behaviors, or broad social causes. Once this has been done a process begins of developing a causal web surrounding the starting point, that identifies increasingly broader, more fundamental social causes of HIV risk and/or increasingly specific risk factors. At each point in this web it is also important to identify the empirical and/or theoretical research documenting associations between causal factors and outcomes. Once the causal web and supporting documentation have been identified, key points in the web where interventions may be particularly effective at reducing incidence are identified. In considering these key points, it is also important to account for the feasibility and acceptability of potential interventions. Using this process, we have identified four key intervention areas for addressing HIV risk in CT drug users: syringe deregulation, drug treatment availability, drug policy reform, and welfare reform.
Learning Objectives: Identify structural interventions for HIV prevention among drug users. Apply a methodology for assessing structural interventions.
Keywords: HIV/AIDS, Intravenous Drug Use
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.