Structural InterventionsCRITICAL TO THE AIDS REPSONSE?

Robert Carr | Director of Policy and Advocacy International Council of AIDS Service Organizations (ICASO)

International Council of AIDS Service Organizations (ICASO)

1Bio-medical sciences’ explanatory ability has proven necessary, but insufficient.

Social Sciences provide key entry point for understanding drivers of

the epidemic.

• Drivers embedded in 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)

2

If we don’t understand the role of the

fundamental building blocks of

society, such as gender, stigma, social

exclusion, etc., we will fail to understand why our programs are working, or are not

working. International Council of AIDS Service Organizations (ICASO)

Pillars of HIV Programming

Enabling Environment• Stigma and Discrimination• Legislative Action/Reform• Human Rights

1

43

2Prevention

• Target Groups• IEC Campaigns• Blood Safety

Monitoring & EvaluationTreatment, Care and Support• Access to ART• Health Systems

Strengthening

International Council of AIDS Service Organizations (ICASO)

Gender AnalysisEnabling 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.

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”

1 2

3 4

International Council of AIDS Service Organizations (ICASO)

HIV Preventio

n

Pre-empts need for treatment

Reduces risk, strengthens communitiesMakes

communities less vulnerable

Pre-empts need

for further mitigation

Treatment and Care

Makes people less susceptible to infection

Addressing the Impact on Human Development

Strengthens systems

for delivery and care

Pre-empts need for future mitigation

STIGMA

HIV/AIDS: Implications for Poverty Reduction, UNDP 2001

International Council of AIDS Service Organizations (ICASO)

Nested realities (also known as the ecological model)

International Council of AIDS Service Organizations (ICASO)

Individual

Relationships (e.g. parents, sexual

partners, sex work clients, drug use partners)

Community and organisations

(e.g. leadership, networks, gender norms, social capital)

Structural/Societal(e.g. cultural values, residence patterns, policies and laws)

Reached through local gatekeepers, employers, educators, local government, kin groups, neighbours etc.

Reached through political groups, lawmakers, religious leaders etc.

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 by and through individuals and their networks

Nested Realities

International Council of AIDS Service Organizations (ICASO)

Individual

THANK YOU!