Understanding and integrating the structural and biomedical determinants of HIV infection: a way forward for prevention

PURPOSE OF REVIEW: As understanding and integrating the structural and biomedical determinants of HIV infection is essential for the success of prevention efforts, there is a need for biomedical and social scientists to work together. RECENT FINDINGS: A review of the biomedical research literature indicates that the two major routes of HIV transmission, sexual and injection drug use behaviours, are primarily understood as biological. A review of the social science literature, however, indicates that such a positioning provides a very weak basis for prevention, as these behaviours or practices are socially produced; that is, they are patterned by socio-cultural, economic and political forces as well as by biological factors. This paper compares successful with unsuccessful prevention interventions/programmes highlighting the central importance of the structural determinants of risk. For HIV-prevention programmes to be effective, the focus must shift from behaviour, for example, from vaginal intercourse, to the cultural forms in which it is enacted; that is, to marriage, concurrent partnering, sex work, and so forth. SUMMARY: This paper concludes that multidisciplinary teams provide a good starting place for the development of effective prevention programmes.