Addressing Social Drivers of HIV/AIDS Some Conceptual, Methodological, and Evidentiary Considerations

Published: June 11, 2011


Interest in enhancing and applying social research in HIV prevention has intensified in recent
years as it has become clear that the development, uptake, and effectiveness of the biomedical
and behavioral strategies for HIV prevention that have dominated the intervention arena are
very much affected by social and cultural contexts.1 Additionally, there is now much wider
recognition that social forces—hereafter referred to as “social drivers”—both influence HIV
transmission (by influencing practices that can lead to infection) and offer possible points of
intervention at the societal level (by altering those practices or the context in which they

This recognition has resulted in a sense of urgency in the public health community to identify
effective social-level, or “structural,” interventions that can be rapidly deployed. But the
arsenal of structural interventions—or, more generally, evidence-based and evidenceinformed
strategies for social change—is quite small, and developments in this arena have
been hampered by significant methodological and evidentiary obstacles that have yet to be
fully explored and redressed.2,3

We believe that further progress in this area involves two things: first, a better development
and mining of the basic social science that should underlie structural intervention design, and
second, a better explication and adoption of research methodologies that can effectively
attribute causality and assess the nature of social-level change. Thus, this paper examines key
issues in the conceptualization, operationalization, and measurement of social drivers of
HIV/AIDS and evaluation of attempts to modify them. Our hope is that a deeper engagement
with social science research and methods will increase the public health community’s
understanding of social drivers and permit the development of appropriate social-level
approaches, including structural interventions that, in turn, will have a greater impact on HIV
epidemics everywhere.

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