A COMPREHENSIVE NEW REFERENCE WORK ON STRUCTURAL APPROACHES TO PREVENTING HIV Structural interventions -- changes to environment aimed at influencing health behaviors -- are the most universal and cost-effective tool in preventing new incidences of HIV. They are not easy to get right, however. Structural Interventions for HIV Prevention offers an authoritative reference for both understanding these programs and instituting them to greatest effect. Whether through changes to policy, environment, social/community norms, or a combination of each, this volume offers actionable and attainable blueprints to creating and evaluating programs in any setting or country. It is an essential resource for researchers and practitioners in the continuing fights against HIV.

​​​​ ​ Providing detailed information on structural HIV prevention interventions, this book is intended for health care practitioners and researchers to plan, implement, and evaluate such interventions in their own communities. As defined by the CDC, structural interventions focus on the physical, social, cultural, political, economic, legal, and/or policy aspects of the environment. Designed to reach a large number of individuals, structural interventions usually occur across entire communities, cities, or countries. As a result, the resources required to initiate structural interventions can far exceed those required for smaller-scale behavioral programs. However, changes from structural interventions have the potential to last over time, even after the programs have ended, resulting in effective use of public and private prevention resources.​ Because the reach of structural interventions is typically larger than that of individual- or group-focused interventions (for example, the 100% Condom Use Program, which was implemented countrywide in Thailand), their influence may be equally—if not more—significant.This book is a resource for health practitioners, educators, and researchers who seek HIV/AIDS structural prevention programs that have been shown to be effective in their regions or for their target populations (e.g. injection drug users, commercial sex workers, or the general public). With extensive case studies, the book classifies interventions according to the desired outcomes (specific behavior or policy changes) so that the reader may focus on examples of programs with similar goals and target populations to their own. Addresses the quintessential public health ethical dilemma regarding which types of environmental changes should be mandatory via legislation and which should be voluntary, promoted via programmatic, practice, and policy change. ​

One in five people in the United States had a sexually transmitted infection (STI) on any given day in 2018, totaling nearly 68 million estimated infections. STIs are often asymptomatic (especially in women) and are therefore often undiagnosed and unreported. Untreated STIs can have severe health consequences, including chronic pelvic pain, infertility, miscarriage or newborn death, and increased risk of HIV infection, genital and oral cancers, neurological and rheumatological effects. In light of this, the Centers for Disease Control and Prevention, through the National Association of County and City Health Officials, commissioned the National Academies of Sciences, Engineering, and Medicine to convene a committee to examine the prevention and control of sexually transmitted infections in the United States and provide recommendations for action. In 1997, the Institute of Medicine released a report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Although significant scientific advances have been made since that time, many of the problems and barriers described in that report persist today; STIs remain an underfunded and comparatively neglected field of public health practice and research. The committee reviewed the current state of STIs in the United States, and the resulting report, Sexually Transmitted Infections: Advancing a Sexual Health Paradigm, provides advice on future public health programs, policy, and research.

Background: One of the biggest racial health disparities in the US concerns HIV/AIDS. African Americans have considerably higher rates of HIV/AIDS than do Whites, Hispanics, Asians, and Native Americans. The predominant approach to prevention has been to mount individual- or small-group multisession behavioral interventions. The reach of such interventions is very limited and thus, the field of HIV prevention has called for structural interventions that reach many people in their natural environments. This dissertation evaluates a serial drama, "Reality Check," which is a structural HIV prevention intervention for, 18-24 year old African Americans.Theory: Bandura's Social Cognitive Theory was used in the development of the intervention. Fishbein and Ajzen's Reasoned Action approach, was used to inform the survey instrument and statistical analysis models. Intervention: "Reality Check" is a 13-episode serial drama. Each day a new 6-9 minute, episode was streamed online while all previous episodes were available on the study's website. In addition to streaming the episodes, emails giving the locations of local venues where free HIV testing is available were sent, so that the barrier of not knowing will not interfere with viewers' ability to be tested should they decide to get tested. Method: A randomized controlled trial with baseline and multiple post- intervention assessments was used to evaluate the efficacy of the intervention. A total of 203 African Americans (162 women and 41 men) aged between 18 and 24 years located anywhere in the United States participated in the study. Confidential online longitudinal surveys were conducted at baseline, immediately after the intervention, and three months after the end of the intervention. The primary outcomes were condomless sex and HIV testing. Results: The intervention reduced the number of times participants reported having condomless sex but did not affect HIV testing. It also reduced homophobia and HIV/AIDS stigma as well as the number of times participants reported having vaginal sexual intercourse. Attrition was remarkably low with 93% and 87% of the participants completing the immediate-post intervention and 3-month follow-up assessments respectively.

Before AIDS, the role of behavioral interventions in preventing transmission of sexually transmitted diseases was acknowledged in text books and journals but rarely promoted effectively in public health practice. This book addresses the complexities and social contexts of human behaviors which spread STDs, the cultural barriers to STD education, and the sociopolitical nuances surrounding treatment.

The AIDS epidemic in Sub-Saharan Africa continues to affect all facets of life throughout the subcontinent. Deaths related to AIDS have driven down the life expectancy rate of residents in Zambia, Kenya, and Uganda with far-reaching implications. This book details the current state of the AIDS epidemic in Africa and what is known about the behaviors that contribute to the transmission of the HIV infection. It lays out what research is needed and what is necessary to design more effective prevention programs.