HIV/AIDS Prevention in the United States: The Need for Structural-Level Interventions

Abstract

This thesis examines the federal government’s current approach to HIV/AIDS prevention in the United States. In 2010, President Obama released the National HIV/AIDS Strategy (NHAS) to direct and to align the nation’s collective HIV/AIDS efforts through 2020. While many institutions and actors are involved with this effort, the Centers for Disease Control and Prevention (CDC) is the lead federal agency responsible for HIV prevention. The NHAS vision emphasizes the role that structural factors play in contributing to our nation’s HIV/AIDS burden. However, the CDC’s prevention strategies revolve around individual-level interventions, like behavior modification programs, rather than structural interventions, like policy advocacy. The CDC enables our country’s HIV/AIDS burden because its individually focused prevention strategies do not adequately map onto the structural-level factors that predominately contribute to the burden. First, I use qualitative data techniques (semi-structured interviews and literature reviews) to show that the CDC’s current behavioral interventions are not suitable for any population because they reflect an over-privileging of scientific authority, evidence-based methodology, and Westernized individualism. Second, I use quantitative data techniques (original statistic regression analyses) to evaluate how well the CDC’s current prevention programs map onto HIV risk factors. My findings revealed that structural-level factors contribute to more variation in HIV incidence rates compared to individual-level factors. Specifically, high school graduation had the largest relative effect on reducing HIV incidence rates, which suggests education has a protective effect on preventing HIV incidence. Third, I provide actionable strategies on how to improve the CDC’s HIV/AIDS prevention efforts within the current HIV/AIDS budget limitations. This section also includes specific policy recommendations detailing the importance of emphasizing education policy as health policy, and more specifically, education policy as HIV prevention policy. To ground my research in real world application, I provide case illustrations of the U.S. South where HIV incidence is currently highest. Ultimately, this thesis argues that order to realize the NHAS goals of reducing HIV/AIDS rates and HIV/AIDS-related disparities, the federal government must better align its interventions with the structural factors that predominately contribute to HIV rates.