Abstract
BackgroundThe fact that HIV prevention often deals with politicised sexual and drug taking behaviour is well known, but structural HIV prevention interventions in particular can involve alteration of social arrangements over which there may be further contested values at stake. As such, normative frameworks are required to inform HIV prevention decisions and avoid conflicts between social goals.MethodsThis paper provides a conceptual review and discussion of the normative issues surrounding structural HIV prevention strategies. It applies political and ethical concepts to explore the contested nature of HIV planning and suggests conceptual frameworks to inform future structural HIV responses.ResultsHIV prevention is an activity that cannot be pursued without making value judgements; it is inherently political. Appeals to health outcomes alone are insufficient when intervention strategies have broader social impacts, or when incidence reduction can be achieved at the expense of other social values such as freedom, equality, or economic growth. This is illustrated by the widespread unacceptability of forced isolation which may be efficacious in preventing spread of infectious agents, but conflicts with other social values.ConclusionsWhile no universal value system exists, the capability approach provides one potential framework to help overcome seeming contradictions or value trade-offs in structural HIV prevention approaches. However, even within the capability approach, valuations must still be made. Making normative values explicit in decision making processes is required to ensure transparency, accountability, and representativeness of the public interest, while ensuring structural HIV prevention efforts align with broader social development goals as well.
Highlights
The field of HIV prevention has increasingly seen calls to undertake structural approaches to HIV
The capability approach can provide a normative framework that defines structural approaches as those which increase the capacity for AIDS resilience, but it does not prescribe the value of HIV prevention vis a vie many of the other social issues with which HIV is linked
Rather than reduction to health outcomes alone, authors in the field of public health, health promotion, and bioethics alike have all noted the importance of value systems in guiding decision making, with the need for a normative approach to avoid tradeoffs between deeply held values in the name of disease prevention
Summary
The field of HIV prevention has increasingly seen calls to undertake structural approaches to HIV. An AIDS resilience approach would not value HIV prevention for its own sake (nor place it above other social goals), but rather work towards building the capacity of individuals and communities to resist HIV.
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