Salisbury, N.A.; (2011) The HIV prevention puzzle: inter-organizational cooperation and the structural drivers of infection. Doctoral thesis , UCL (University College London).

Abstract

Despite evidence to support ‘what works’ in HIV prevention, new infections remain unacceptably high, particularly where epidemics are generalized, amounting to a ‘puzzle’ in HIV prevention. This research will examine the extent to which a gap exists in the actual substantive underpinnings of prevention programmes, and/or in the design and effectiveness of the governance of HIV. A persistent critique of prevention efforts is the inattention paid to structural risks, vulnerabilities that predispose individuals, and populations, to engaging in high-risk behavior. Structural approaches to HIV prevention have not yet been incorporated in a widespread manner. Reasons include a lack of expertise among health professionals, complications inherent to multi-sectoral coordination, a lack of evidence to support their efficacy, and resources. Another explanation is that the network of organizations, funding and implementing HIV prevention, prefers behavioral and biomedical approaches, making it difficult for structural approaches to make their way onto the agenda. A network approach is premised on the idea that organizations are likely to act in accordance with those to whom they are closely connected. This research provides an analysis of the structure of relations between prevention organizations in KwaZulu-Natal, South Africa, and will assess whether position within this network determines organizational preference for structural (or other) approaches to HIV prevention. Data was collected using a survey and interviews, and analyzed using formal network analysis methods, and interpretive content analysis. There are a number of findings of note. While extensive networking opportunities exist, many CBOs remain isolated from such support structures. Where greater connectivity did exist, organizations provided an impressive range of services. An unexpectedly high proportion expressed a preference for structural approaches to HIV prevention. However, the translation into policy was mixed. Crucially, dedicated resources for HIV prevention among implementers were severely lacking, be they for structural, behavioral or biomedical approaches. A re-commitment to ‘Universal Access to HIV prevention’ is therefore most timely.

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