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The importance of choice disability and structural intervention in the HIV epidemic in Sub-Saharan Africa

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  • Rebecca de Boer
  • Jeffrey Musgrave
  • Neil Andersson
  • Frithjof Lutscher

Abstract

Background: Despite massive investment in HIV control programs, HIV incidence rates in countries with generalized epidemics have not fallen for most of the last decade. It appears that those at risk are not adopting effective prevention strategies. Those who are unable to implement their prevention preferences are referred to as choice disabled. We examined how and to what extent structural intervention measures that support choice-disabled individuals can reduce HIV transmission and prevalence. Methods: A mathematical model was developed to describe HIV transmission among and between choice-disabled and choice-enabled individuals. Data were available from field trials identifying factors and effects of choice disability. The model was used to estimate the potential impact of an intervention strategy in which choice-disabled individuals are enabled to make prevention choices. Several scenarios were considered and compared: supporting only one or both genders; supporting only HIV– individuals or also HIV+ choice-disabled individuals. Results: Substantial declines in HIV incidence and prevalence are observed when supportive interventions are included in the model. The magnitude of these declines depends on the scope of the intervention program. The largest positive effect occurs when the support program is offered regardless of HIV status. Conclusions: Addressing the effects of choice disability in any HIV intervention program could be crucial to the program’s success. Structural intervention programs to support choice-disabled individuals in implementing prevention strategies greatly reduce HIV incidence and prevalence in mathematical models.

Suggested Citation

  • Rebecca de Boer & Jeffrey Musgrave & Neil Andersson & Frithjof Lutscher, 2017. "The importance of choice disability and structural intervention in the HIV epidemic in Sub-Saharan Africa," PLOS ONE, Public Library of Science, vol. 12(4), pages 1-14, April.
    • Handle: RePEc:plo:pone00:0175297
    DOI: 10.1371/journal.pone.0175297
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    References listed on IDEAS

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    1. Bradley G Wagner & Sally Blower, 2012. "Universal Access to HIV Treatment versus Universal ‘Test and Treat’: Transmission, Drug Resistance & Treatment Costs," PLOS ONE, Public Library of Science, vol. 7(9), pages 1-8, September.
    2. Hallfors, D. & Cho, H. & Rusakaniko, S. & Iritani, B. & Mapfumo, J. & Halpern, C., 2011. "Supporting adolescent orphan girls to stay in school as HIV risk prevention: Evidence from a randomized controlled trial in Zimbabwe," American Journal of Public Health, American Public Health Association, vol. 101(6), pages 1082-1088.
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