Recent advances in bio-medical prevention of HIV, such as a daily pill to reduce infections for people at high risk, have been cause for celebration at the XIX International AIDS Conference (AIDS 2012) in Washington DC. Yet advocates note that structural and environmental factors influence how well medical advances will fulfill their promise. The STRIVE Research Consortium, launched this week, will demonstrate the ways in which social and economic forces drive vulnerability to HIV and hinder effective prevention and treatment efforts.
As the range of effective prevention technologies expands, “we need to keep our eyes on the prize of enabling factors to make sure those technologies work,” said Dr Lori Heise, STRIVE chief executive and a lecturer at the London School of Hygiene and Tropical Medicine. Most of our current medical and behavioural interventions focus on individual choice, without recognizing the social, economic, or cultural context that constrains those choices, Dr Heise explained. Counseling women to “have fewer partners” is less effective without efforts to improve livelihoods in settings where women may depend on relationships for economic security. Even highly effective medical interventions, such as single dose anti-retrovirals to prevent transmission of HIV from mothers to babies at birth, or PMTCT, are undermined by structural factors such as lack of access to formal healthcare, or stigma in the family, community or health system, noted Professor Charlotte Watts, STRIVE Research Co-director.
The STRIVE agenda builds on existing evidence on structural and social factors driving the HIV/AIDS epidemic. In addition to deepening understanding of how these factors affect HIV risk, the research will evaluate the likelihood of “upstream” interventions to reduce people’s vulnerability. Key areas of research include criminalization of “risk” behaviours, stigma, gender norms, economic opportunity, mobility, alcohol availability, and violence. The consortium has partners from India, South Africa and Tanzania as well as the US and UK, with initial funding from UKAid.
There is a long history of the impact of structural interventions on public health, yet the impulse is to develop new technologies rather than challenge entrenched systems. The STRIVE consortium seeks to generate compelling evidence that will push governments and funding organizations to tackle the long-standing structural issues that undermine efforts to end AIDS.
Megan Gottemoeller - CNS