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Structural Interventions

Structural Interventions. C RITICAL TO THE AIDS R EPSONSE?. Robert Carr | Director of Policy and Advocacy International Council of AIDS Service Organizations (ICASO). Bio-medical sciences’ explanatory ability has proven necessary, but insufficient. 1.

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Structural Interventions

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  1. Structural Interventions CRITICALTO THE AIDS REPSONSE? Robert Carr | Director of Policy and Advocacy International Council of AIDS Service Organizations (ICASO)

  2. Bio-medical sciences’ explanatory ability has proven necessary, butinsufficient. 1 International Council of AIDS Service Organizations (ICASO)

  3. 2 Social Sciences provide key entry point for understanding drivers of the epidemic. • Drivers embeddedin social structure. • Understanding of role of social structures central to both“know our epidemic”and“know our response”. • Problem lingers of bio-medical dominance of what constitutes“evidence”. International Council of AIDS Service Organizations (ICASO)

  4. If we don’tunderstandtheroleof thefundamental building blocks of society,such asgender, stigma, social exclusion,etc.,we willfail to understand whyour programsareworking,or are not working. International Council of AIDS Service Organizations (ICASO)

  5. Pillars of HIV Programming • Prevention • Target Groups • IEC Campaigns • Blood Safety Enabling Environment • Stigma and Discrimination • Legislative Action/Reform • Human Rights 2 1 • Treatment, Care and Support • Access to ART • Health Systems Strengthening Monitoring & Evaluation 3 4 International Council of AIDS Service Organizations (ICASO)

  6. Gender Analysis • Enabling Environment • Social and cultural factors that make women vulnerable, are often left untouched. • Prevention • Assumptions of control over when, where and how sex takes place. 2 1 • Treatment, Care and Support • Access to ART – self interested individualism • Care and Support “soft” issues compared to ART • Monitoring & Evaluation • Does not take gender analysis into account • Gender “blind” 4 3 International Council of AIDS Service Organizations (ICASO)

  7. Treatment and Care HIV Prevention Pre-empts need for treatment Reduces risk, strengthens communities Makes communities less vulnerable Pre-empts need for further mitigation Strengthens systems for delivery and care Pre-empts need for future mitigation Makes people less susceptibleto infection STIGMA Addressing the Impact on Human Development HIV/AIDS: Implications for Poverty Reduction, UNDP 2001 International Council of AIDS Service Organizations (ICASO)

  8. Nested realities(also known as the ecological model) International Council of AIDS Service Organizations (ICASO)

  9. Ecological models illustrate “levels” or “layers” of influence that affect individual opportunities and choices. Different stakeholders operate at these different “layers” and all must be reached using appropriate channels and activities in order to shift the barriers to universal access. Reached through political groups, lawmakers, religious leaders etc. Reached through local gatekeepers, employers, educators, local government, kin groups, neighbours etc. Reached by and through individuals and their networks Structural/Societal(e.g. cultural values, residence patterns, policies and laws) Community and organisations (e.g. leadership, networks, gender norms, social capital) Relationships (e.g. parents, sexual partners, sex work clients, drug use partners) Individual Nested Realities Individual International Council of AIDS Service Organizations (ICASO)

  10. THANK YOU!

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