Intimacy to develop incrementally and to disclose as trust builds is eliminated or at least burdened with the possibility of felony charges. Structural interventions can also compromise autonomy by imposing the interventionists’ priorities and values. In most cases, interventionists operate under the assumption that health takes precedence over any priorities that the intervention efforts replace (e.g., pleasure, relationship development, economic security). When these assumptions serve as a basis for structural interventions, the affect of which may be virtually unavoidable for those in the intervention area, the intervention effectively imposes this priority on others. Micro finance interventions are based on the assumption that individuals should welcome the opportunity to become entrepreneurs. However, many of these endeavors produced mixed results, in part because entrepreneurship is not universally desirable.97,98 Efforts to routinely test all U.S. adults can serve as another example. While concentrating on the important goal of testing individuals for HIV infection, practitioners may persuade individuals to be tested at a time when an HIV-positive diagnosis could topple an already unstable housing or employment situation or end a primary relationship. Structural interventions can also incur risk for persons who do not consent to test. Routine HIV testing increases the likelihood that some persons will be diagnosed with HIV or another condition when they do not have health insurance. The intervention then creates a documented preexisting condition and may preclude an individual from receiving health benefits in theAIDS Behav. Author manuscript; available in PMC 2011 December 1.Latkin et al.Pagecontext of current insurance coverage standards. Increasing risk for individuals who have not consented to this new risk is especially of concern if the individual who is put at risk by the intervention does not receive benefit from the intervention. This occurs, for example, with criminal HIV disclosure laws, which increase the risk of unwanted secondary disclosure of HIV-positive persons’ serostatus by requiring disclosure if they want to engage in sex. Because structural interventions make system wide changes, there is the risk that intervening factors may produce unanticipated and potentially deleterious outcomes. These outcomes may not only be difficult to anticipate, they may be difficult to neutralize or to control. Public trust, once called into HS-173MedChemExpress HS-173 question, especially by persons who occupy marginal positions in society, may be exceedingly difficult to regain. The collective memory of a community is a significant structure in itself. Methods to Study Structural Factors The broad scope and complex nature of structural factors and structural interventions create myriad challenges for research. Studies of structural factors affecting HIV-related behavior have fallen into three general categories. The first approach is to assess the impact of structural interventions at the macro, meso, and micro Caspase-3 Inhibitor site levels that were not initially designed to change HIV-related behaviors directly. The second is to assess structural factors that shape the context and processes of the epidemic and its eradication. A third approach includes experimental tests of the effects of structural interventions specifically designed to reduce the transmission and impact of HIV. One example of the first approach is to assess the impact of district-wide interventions to redu.Intimacy to develop incrementally and to disclose as trust builds is eliminated or at least burdened with the possibility of felony charges. Structural interventions can also compromise autonomy by imposing the interventionists’ priorities and values. In most cases, interventionists operate under the assumption that health takes precedence over any priorities that the intervention efforts replace (e.g., pleasure, relationship development, economic security). When these assumptions serve as a basis for structural interventions, the affect of which may be virtually unavoidable for those in the intervention area, the intervention effectively imposes this priority on others. Micro finance interventions are based on the assumption that individuals should welcome the opportunity to become entrepreneurs. However, many of these endeavors produced mixed results, in part because entrepreneurship is not universally desirable.97,98 Efforts to routinely test all U.S. adults can serve as another example. While concentrating on the important goal of testing individuals for HIV infection, practitioners may persuade individuals to be tested at a time when an HIV-positive diagnosis could topple an already unstable housing or employment situation or end a primary relationship. Structural interventions can also incur risk for persons who do not consent to test. Routine HIV testing increases the likelihood that some persons will be diagnosed with HIV or another condition when they do not have health insurance. The intervention then creates a documented preexisting condition and may preclude an individual from receiving health benefits in theAIDS Behav. Author manuscript; available in PMC 2011 December 1.Latkin et al.Pagecontext of current insurance coverage standards. Increasing risk for individuals who have not consented to this new risk is especially of concern if the individual who is put at risk by the intervention does not receive benefit from the intervention. This occurs, for example, with criminal HIV disclosure laws, which increase the risk of unwanted secondary disclosure of HIV-positive persons’ serostatus by requiring disclosure if they want to engage in sex. Because structural interventions make system wide changes, there is the risk that intervening factors may produce unanticipated and potentially deleterious outcomes. These outcomes may not only be difficult to anticipate, they may be difficult to neutralize or to control. Public trust, once called into question, especially by persons who occupy marginal positions in society, may be exceedingly difficult to regain. The collective memory of a community is a significant structure in itself. Methods to Study Structural Factors The broad scope and complex nature of structural factors and structural interventions create myriad challenges for research. Studies of structural factors affecting HIV-related behavior have fallen into three general categories. The first approach is to assess the impact of structural interventions at the macro, meso, and micro levels that were not initially designed to change HIV-related behaviors directly. The second is to assess structural factors that shape the context and processes of the epidemic and its eradication. A third approach includes experimental tests of the effects of structural interventions specifically designed to reduce the transmission and impact of HIV. One example of the first approach is to assess the impact of district-wide interventions to redu.
