The Structural Interventions Working Group

Recognizing the Role of Structural Drivers and the Need for Social Interventions in Improving Health Outcomes for PLWHA

Social interventions, most often in the form of support services, are fundamental to making health care work for people living with HIV/AIDS (PLWHA). As the HIV epidemic in the United States increasingly impacts low-income individuals, support services help stabilize individuals living with or at risk of HIV by providing a safe home, sufficient food, and assistance in obtaining employment. When these needs are met, and life’s emergencies are held at bay, PLWHA are poised to remain connected to care and treatment.

Poverty and its manifestations are essentially destabilizing, making adherence to a demanding medical regimen eminently challenging. Low income people are more likely to experience homelessness and food insecurity. Homeless or marginally housed individuals are more likely to delay treatment, less likely to have regular access to care, less likely to receive optimal drug therapy, and less likely to adhere to their medication than are stably housed individuals—all of which increase the individual’s viral load and decrease health outcomes. According to one study of people living with HIV and AIDS (PLWHA), more than one-third went without care or postponed care due to needing the money for food, clothing, or housing or another competing need. Meanwhile, PLWHA who are employed have better adherence to treatment and better health outcomes.

The National HIV/AIDS Strategy for the United States (NHAS), released in July 2010, set out three main goals: 1) reducing the number of people who become infected with HIV, 2) increasing access to care and optimizing health outcomes for people living with HIV, and 3) reducing HIV-related health disparities. Because of the strong impact they have on maintenance in care and treatment and improved health outcomes, support services are elemental to achieving the country’s HIV policy objectives. In fact, recognizing that financial constraints and preoccupation with immediate needs present substantial barriers to accessing medical care, the NHAS underscores the fundamental role of social services in prevention strategies and encourages “policies to promote access to housing and supportive services … that enable people living with HIV to obtain and adhere to HIV treatment.”

Studies repeatedly show that supportive services help reduce risk-taking behaviors, help people connect to care and remain in care, and adhere to treatment. In turn, supportive services have been shown both to improve health outcomes and reduce costs. Structural interventions, then, are instrumental in achieving the goals of the NHAS, and improving individual and public health.

Currently the Structural Interventions Working Group represents the following fields:

Please follow their respective links for more information, research and advocacy materials related to each intervention.

People living with HIV/AIDS must often balance competing demands on their time, attention and resources. Supportive services, including housing, food and nutrition services, and vocational rehabilitation help low income PLWHA to comply with complex medical regimens, despite the rigors of living in poverty. For too many people living with HIV/AIDS, there can be no effective medical care without supportive services.