Structural barriers and facilitators in HIV prevention: a review of international research
Richard G. Parker, Delia Easton and Charles H. Klein
Paper provides an overview of the structural and environmental factors which are effective in distribution of the HIV/AIDS epidemic. In addition, it has investigated the role of these factors in facilitating or hindering the HIV-prevention programs. A large group of international studies have reviewed in order to identify the main lines of research activity in this area. Based on this review it was revealed that the factors fall into three interconnected categories which are economic development and poverty; mobility including migration, population movement due to seasonal work, wars and political instability; and gender inequalities.
The study found that economic development can positively affect the HIV/AIDS vulnerability. Moreover the migration and mobility of people such as those who immigrate from rural to urban areas can be significantly linked to increased HIV incidence and vulnerability of this devastating disease. On the other hand, political instability can intensify poverty and stimulates migration to big cities, where a number of factors like sexism, sexual-union patterns can all cause HIV distribution. Political economic factors make HIV epidemic closely related to gender and sexuality structures that within society hierarchies women, and specially low-income women are highly exposed to HIV infection.
Besides these categories, it was found that some particular public-health policies such as structural policies and the socioeconomic instabilities, national HIV/AIDS policies, international injecting-drug-related policies and ethical and human right issues play an important role in increasing or reducing HIV vulnerability and transmission.
Some specific environmental structures are investigated in detail in order to find more extensice references on this topic. Among them heterosexual women, female sex workers, truch drivers and men who have sex with men are four groups of people who have participated in this section.
In conclusion, a number of innovative and interdisciplinary approaches are needed that can move beyond the limited successes of traditional behavioral interventions and more research must be undertaken to achieve broader social and structural change.
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