How do we address social and structural barriers to meet the needs of key populations and other groups at heightened risk?


Marginalized communities—including “key populations” like female sex workers or men who have sex with men—often are disproportionately affected by HIV, a situation exacerbated by deeply entrenched social and structural barriers to health. Globally, a host of detrimental legal, policy, and sociocultural factors inhibits efforts to meet the HIV-related needs of such vulnerable communities. For example, in settings where anti-gay discrimination is codified into law or where sex work is criminalized, communities who engage in these stigmatized behaviors are driven underground, further complicating efforts to ensure they are reached and engaged by critical health care services and information. In sub-Saharan Africa, the epicenter of the HIV epidemic, harmful gender norms are a driving force underlying the heavy HIV burden borne by adolescent girls and young women. Traditional societal expectations about how men and women should behave can contribute to pernicious gender inequities, with women’s HIV risk exacerbated by experiences of intimate partner violence, unequal access to education, and male-dominant power dynamics.
Programs that attempt to address these social and structural barriers focus on effecting change in the broader environment in which these communities exist. Examples include interventions that aim to improve gender norms among community members, or to reduce stigmatizing attitudes among healthcare providers. The SOAR research portfolio includes activities that test and evaluate these types of “structural interventions,” which ultimately seek to remove impediments to HIV services and reduce risky behaviors.