Social determinants, structural interventions, women’s health, HIV prevention


The design and implementation of structural interventions may provide for simultaneous and longitudinal responses to prevention needs in multiple contexts as defined by social determinants, thus varied opportunities exist to respond to the HIV prevention needs of women. According to the CDC, in 2010, the rate of new HIV infections among black women was 20 times that of white women, and the rate among Hispanic/Latino women was 4 times the rate of white women. Additionally, 86% of HIV infections in women were attributed to heterosexual contact and 14% to injection drug use (CDC, 2012). These numbers are reflected outside the US with 49% of those infected by HIV being women with a predominant source of infection being related to heterosexual transmission (WHO, 2008). In sub-Saharan Africa, of those living with HIV, 60% are women.

Attention to the influential context of social determinants of health provides unique opportunities for innovative prevention practice in HIV/AIDS prevention for women. In this paper, social determinants of health as an influential, behavioral concept is defined both in terms of women’s health and their sexual behavior decision making, along with examples of potential structural interventions that not only address the social determinants of their HIV risks but also reflect the contextual complexity of their life experiences. An earlier study (Abdul-Qader and Collins, 2011) solicited statements from a sample of experts in HIV prevention and areas of public health to identify potential structural interventions that would be feasible and impactful regarding HIV prevention - the DHAP Structural Interventions Mapping project. Data was elicited from these stakeholders most likely to be designing and guiding interventions to determine their perspectives on feasible and impactful structural intervention to address sexual behavior in women. The current paper is based on secondary analysis of 20 of these potential structural interventions generally and specifically applicable to women and their HIV prevention needs. Qualitative analysis resulted in three overall themes of economic interventions, response to violence against women and integrated health service delivery strategies that address key health-belief and socio-cultural issues. The themes are reflected and substantiated in current research literature, and provide a foundation for the next steps regarding research, policy planning and program implementation for developing evidence-based structural interventions focused on preventing HIV in women.


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