Center for Global Health, Massachusetts General Hospital, Boston, MA 02114, United States.
Soc Sci Med. 2012 Nov;75(9):1562-7; discussion 1568-71. doi: 10.1016/j.socscimed.2012.06.033. Epub 2012 Jul 31.
Renewed enthusiasm for biomedical HIV prevention strategies has followed the recent publication of several high-profile HIV antiretroviral therapy-based HIV prevention trials. In a recent article, Roberts and Matthews (2012) accurately note some of the shortcomings of these individually targeted approaches to HIV prevention and advocate for increased emphasis on structural interventions that have more fundamental effects on the population distribution of HIV. However, they make some implicit assumptions about the extent to which structural interventions are user-independent and more sustainable than biomedical or behavioral interventions. In this article, I elaborate a simple typology of structural interventions along these two axes and suggest that they may be neither user-independent nor sustainable and therefore subject to the same sustainability concerns, costs, and potential unintended consequences as biomedical and behavioral interventions.
随着最近几项备受瞩目的基于抗逆转录病毒疗法的艾滋病预防治疗试验的公布，人们对生物医学艾滋病预防策略重新产生了热情。在最近的一篇文章中，罗伯茨和马修斯（2012 年）准确地指出了这些针对艾滋病预防的个别靶向方法的一些缺点，并主张更加重视对人口中艾滋病毒分布有更根本影响的结构性干预措施。然而，他们对结构性干预措施在多大程度上不依赖用户以及比生物医学或行为干预措施更可持续性做出了一些隐含的假设。在本文中，我沿着这两个轴对结构性干预措施进行了简单的分类，并提出它们既不依赖用户，也不可持续，因此与生物医学和行为干预措施一样，也存在可持续性问题、成本问题和潜在的意外后果。
