Operationalising Structural Interventions for HIV Prevention: Lessons from Zambia

In recent years, as combination prevention approaches have become the mainstay of HIV prevention responses globally, significant gaps in implementing structural interventions have been recognised [1, 2]. The discussion around structural HIV prevention has been largely informed by academic literature, but, increasingly, programmatic data are available [3-5]. Consensus on the specific definitions of structural barriers, factors, and interventions is lacking, which often causes confusion in identifying specific and appropriate interventions at the programme level, though other authors in this series attempt to address this gap [6]. Parkhurst defines structural interventions as activities that address structural drivers (both risk drivers and environmental mediators) in a given setting [6]. Despite challenges, HIV prevention programmers have successfully utilised existing knowledge to implement context-specific structural interventions, recognising that removing or alleviating structural barriers is likely to have long-term impact not only on HIV incidence, but also on broader development goals.

In the present paper, the authors describe the experience of programming structural interventions in Zambia, beginning with a brief description of the HIV and AIDS situation and responses in the country, followed by an overview of structural interventions being implemented. We conclude with several overarching and cross-cutting challenges and opportunities in implementing structural interventions, alongside recommendations for a way forward for other countries.