Structural Interventions with an Emphasis on Poverty and Racism



HIV/AIDS continues to disproportionately affect African Americans. While African Americans represent 13% of the U.S. population, they account for nearly 50% of new HIV/AIDS infections (Centers for Disease Control and Prevention (CDC), 2008; McKinnon, 2003). Disproportionate rates are seen most among African American men who have sex with men (MSM) and women. Many African Americans at risk for acquiring HIV or other STIs disproportionately live in poverty and are plagued by communities with high rates of homelessness, unemployment, incarceration and substance abuse/dependence (Adimora & Schoenbach, 2005). How such factors increase the probability of exposure is very complex.


Sexual Minority Residential Segregation African American Community African American Adolescent Kaiser Family Foundation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Adimora, A. A., & Schoenbach, V. J. (2002). Contextual factors and the black-white disparity in heterosexual HIV transmission. Epidemiology, 13, 707–712.PubMedCrossRefGoogle Scholar
  2. Adimora, A. A., & Schoenbach, V. J. (2005). Social context, sexual networks, and racial disparities in rates of sexually transmitted infections. The Journal of Infectious Diseases, 191, S115–S122.PubMedCrossRefGoogle Scholar
  3. Adimora, A. A., Schoenbach, V. J., Martinson, F. E., Coyne-Beasley, T., Doherty, I., et al. (2006). Heterosexually transmitted HIV infection among African Americans in North Carolina. Journal of Acquired Immune Deficiency Syndromes, 41, 616–623.PubMedCrossRefGoogle Scholar
  4. Aidala, A., Cross, J. E., Stall, R., Harre, D., & Sumartojo, E. (2005). Housing status and HIV risk behaviors: Implications for prevention and policy. AIDS and Behavior, 9, 251–265.PubMedCrossRefGoogle Scholar
  5. Albert, A. E., Warner, D. L., & Hatcher, R. A. (1998). Facilitating condom use with clients during commercial sex in Nevada’s legal brothels. American Journal of Public Health, 88, 643–646.PubMedCrossRefGoogle Scholar
  6. Aral, S. O., Adimora, A., & Fenton, K. (2008). Understanding and responding to disparities in HIV and other sexually transmitted infections in African Americans. Lancet, 372, 337–340.PubMedCrossRefGoogle Scholar
  7. Arrington-Sanders, R., Ellen, J., Trent, M. (2008). HIV testing in adolescents and young adults receiving STI testing in an urban primary care setting. Sex Transm Dis, 35, 686–688.Google Scholar
  8. Arrington-Sanders, R., Ellen, J. (2009). Prevalence of self-reported human immunodeficiency virus testing among a population-based sample of urban African-American adolescents. J Adolesc Health, 43, 306–308.Google Scholar
  9. Ashburn, K., Kerrigan, D., & Sweat, M. (2008). Micro-credit, women’s groups, control of own money: HIV-related negotiation among partnered Dominican women. AIDS and Behavior, 12, 396–403.PubMedCrossRefGoogle Scholar
  10. Baicker, K., Chandra, A., & Skinner, J. S. (2005). Geographic variation in health care and the problem of measuring racial disparities. Perspectives in Biology and Medicine, 48, S42–S53.PubMedGoogle Scholar
  11. Bailey, J. E., Van Brunt, D. L., Raffanti, S. P., Long, W. J., & Jenkins, P. H. (2003). Improvements in access to care for HIV and AIDS in a statewide Medicaid managed care system. The American Journal of Managed Care, 9, 595–602.PubMedGoogle Scholar
  12. Barnes, W., D’Angelo, L., Yamazaki, M., Belzer, M., Schroeder, S., et al. (2010). Identification of HIV-infected 12- to 24-year-old men and women in 15 US cities through venue-based testing. Arch Pediatr Adolesc Med, 164, 273–276.Google Scholar
  13. Basu, I., Jana, S., Rotheram-Borus, M. J., Swendeman, D., Lee, S. J., et al. (2004). HIV prevention among sex workers in India. Journal of Acquired Immune Deficiency Syndromes, 36, 845–852.PubMedCrossRefGoogle Scholar
  14. Bernard, D., Kippax, S., & Baxter, D. (2008). Effective partnership and adequate investment underpin a successful response: Key factors in dealing with HIV increases. Sexual Health, 5, 193–201.PubMedCrossRefGoogle Scholar
  15. Braithwaite, R. L., & Arriola, K. R. (2003). Male prisoners and HIV prevention: A call for action ignored. American Journal of Public Health, 93, 759–763.PubMedCrossRefGoogle Scholar
  16. Cason, C., Orrock, N., Schmitt, K., Tesoriero, J., Lazzarini, Z., & Sumartojo, E. (2002). The impact of laws on HIV and STD prevention. The Journal of Law, Medicine & Ethics, 30, 139–145.Google Scholar
  17. Centers for Disease Control and Prevention. (2005). HIV prevalence, unrecognized infection and HIV testing among men who have sex with men−five US cities, June 2004-April 2005. MMWR Morb Mortal Wkly Rep, 54, 597–601.Google Scholar
  18. Centers for Disease Control and Prevention. (2008). HIV prevalence estimates – United States, 2006. Morbidity and Mortality Weekly Report, 57, 1073–1076.Google Scholar
  19. Cohen, D. (1999). Cost as a barrier to condom use: The evidence for condom subsidies in the United States. American Journal of Public Health, 89, 567–568.PubMedCrossRefGoogle Scholar
  20. Cohen, J. (2004). HIV/AIDS in India. Sonagachi sex workers stymie HIV. Science, 304, 560.Google Scholar
  21. Cohen, D., Spear, S., Scibner, R., Kissinger, P., Mason, K., & Wildgen, J. (2000). “Broken windows” and the risk of gonorrhea. American Journal of Public Health, 90, 230–236.PubMedCrossRefGoogle Scholar
  22. Crosby, R. A., Holtgrave, D. R., DiClemente, R. J., Wingwood, G. M., & Gayle, J. A. (2003). Social capital as a predictor of adolescents’ sexual risk behavior: A state-level exploratory study. AIDS and Behavior, 7, 245–252.PubMedCrossRefGoogle Scholar
  23. Dasinger, L. K., & Speiglman, R. (2007). Homelessness prevention: The effect of a shallow rent subsidy program on housing outcomes among people with HIV or AIDS. AIDS and Behavior, 11, 128–139.PubMedCrossRefGoogle Scholar
  24. Des Jarlais, D. C. (2000). Structural interventions to reduce HIV transmission among injection drug users. AIDS, 14, 46.CrossRefGoogle Scholar
  25. Dodd, R. Y. (2004). Current safety of the blood supply in the United States. International Journal of Hematology, 80, 301–305.PubMedCrossRefGoogle Scholar
  26. Doty, M. M., & Holmgren, A. L. (2006). Health care disconnect: Gaps in coverage and care for minority adults. Findings from the commonwealth fund biennial health insurance survey (2005). Issue Brief – Commonwealth Fund, 21, 1–12.PubMedGoogle Scholar
  27. Drucker, E., Lurie, P., Wodak, A., & Alcabes, P. (1998). Measuring harm reduction: The effects of needle and syringe exchange programs and methadone maintenance on the ecology of HIV. AIDS, 12, S217–S230.PubMedCrossRefGoogle Scholar
  28. Fehrs, L. J., Fleming, D., Foster, L. R., McAlister, R. O., Fox, V., et al. (1988). Trial of anonymous versus confidential human immunodeficiency virus testing. Lancet, 8607, 379–382.Google Scholar
  29. Fehrs, L. J., Foster, L. R., Fox, V., et al. (1988). Trial of anonymous versus confidential human immunodeficiency virus testing. Lancet, 332, 379–382.CrossRefGoogle Scholar
  30. Fullilove, R.E., & National Minority AIDS Council. (2006). African Americans, health disparities and HIV/AIDS: Recommendations for confronting the epidemic in Black America: 2006 Fullilove report. Retrieved April 27, 2009 from action?file=grpp/african%20americans,%20health%20disparities%20and%20hiv/aids.pdf
  31. Giordano, P. C., Manning, W. D., & Longmore, M. A. (2005). The romantic relationships of African-American and white adolescents. The Sociological Quarterly, 46, 545–568.CrossRefGoogle Scholar
  32. Gorbach, P. M., Ryan, C., Saphonn, V., & Detels, R. (2002). The impact of social, economic and political forces on emerging HIV epidemics. AIDS, 16, 35–43.Google Scholar
  33. Groseclose, S. L., Weinstein, B., Jones, S. T., Valleroy, L. A., Fehrs, L. J., & Kassler, W. J. (1995). Impact of increased legal access to needles and syringes on practices of injecting-drug users and police officers- Connecticut, 1992–1993. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 10, 82–89.PubMedGoogle Scholar
  34. Gupta, G. R., Parkhurst, J. O., Ogden, J. A., Aggleton, P., & Mahal, A. (2008). Structural approaches to HIV prevention. Lancet, 372, 764–775.PubMedCrossRefGoogle Scholar
  35. Guttmacher Institute. State policies in brief: Sex and STI/HIV education. Retrieved April 27, 2009 from
  36. Harvey, P. D. (1994). The impact of condom prices on sales in social marketing programs. Studies in Family Planning, 25, 52–58.PubMedCrossRefGoogle Scholar
  37. Heimberger, T. S., Chang, H. G., Birkhead, G. S., DiFerdinando, G. D., Greenberg, A. J., et al. (1993). High prevalence of syphilis detected through a jail screening program. A potential public health measure to address the syphilis epidemic. Archives of Internal Medicine, 153, 1799–1804.PubMedCrossRefGoogle Scholar
  38. Hellard, M. E., & Aitken, C. K. (2004). HIV in prison: What are the risks and what can be done? Sexual Health, 1, 107–113.PubMedCrossRefGoogle Scholar
  39. Holtgrave, D. R., Briddell, K., Little, E., Bendixen, A. V., Hooper, M., et al. (2007). Cost and threshold analysis of housing as an HIV prevention intervention. AIDS and Behavior, 11, S162–S166.CrossRefGoogle Scholar
  40. Huo, D., Bailey, S. L., Hershow, R. C., & Ouellet, L. (1998). Drug use and HIV risk practices of secondary and primary needle exchange users. AIDS Education and Prevention, 17, 170–184.CrossRefGoogle Scholar
  41. Huo, D., & Ouellet, L. J. (2007). Needle exchange and injection-related risk behaviors in Chicago: A longitudinal study. Journal of Acquired Immune Deficiency Syndromes, 45, 108–114.PubMedCrossRefGoogle Scholar
  42. Huo, D., & Ouellet, L. J. (2009). Needle exchange and sexual risk behaviors among a cohort of injection drug users in Chicago, Illinois. Sexually Transmitted Diseases, 36, 35–40.PubMedCrossRefGoogle Scholar
  43. Jana, S., Basu, I., Rotheram-Borus, M. J., & Newman, P. A. (2004). The Sonagachi project: A sustainable community intervention program. AIDS Education and Prevention, 16, 405–414.PubMedCrossRefGoogle Scholar
  44. Kahn, J. G., Haile, B., Kates, J., & Chang, S. (2001). Health and federal budgetary effects of increasing access to antiretroviral medications for HIV by expanding Medicaid. American Journal of Public Health, 91, 1464–1473.PubMedCrossRefGoogle Scholar
  45. Kaufmann, G. R., Zaunders, J. J., Cunningham, P., Kelleher, A. D., Grey, P., et al. (2000). Rapid restoration of CD4 T cell subsets in subjects receiving antiretroviral therapy during primary HIV-1 infection. AIDS, 14, 2643–2651.PubMedCrossRefGoogle Scholar
  46. Kerrigan, D., Moreno, L., Rosario, S., Gomez, B., Jerez, H., et al. (2006). Environmental-structural interventions to reduce HIV/STI risk among female sex workers in the Dominican Republic. American Journal of Public Health, 96, 120–125.PubMedCrossRefGoogle Scholar
  47. Khan, M. R., Miller, W. C., Shoenbach, V. J., Weir, S. S., Kaufman, J. S., et al. (2008). Timing and duration of incarceration and high-risk sexual partnerships among African Americans in North Carolina. Annals of Epidemiology, 18, 403–410.PubMedCrossRefGoogle Scholar
  48. Kidder, D. P., Wolitski, R. J., Campsmith, M. L., & Nakamura, G. V. (2007). Health status, health care use, medication use, and medication adherence among homeless and housed people living with HIV/AIDS. American Journal of Public Health, 97, 2238–2245.PubMedCrossRefGoogle Scholar
  49. Kidder, D. P., Wolitski, R. J., Royal, S., Aidala, A., Courtenay-Quirk, C., et al. (2007). Access to housing as a structural intervention for homeless and unstably housed people living with HIV: Rationale, methods, and implementation of the housing and health study. AIDS and Behavior, 11, 149–161.PubMedCrossRefGoogle Scholar
  50. Kippax, S., & Race, K. (2003). Sustaining safe practice: Twenty years on. Social Science & Medicine, 57, 1–12.CrossRefGoogle Scholar
  51. Kirby, D. (1999). Sexuality education: It can reduce unprotected intercourse. SIECUS Report, 21, 19–25.Google Scholar
  52. Kirby, D. B., Laris, B. A., & Rolleri, L. A. (2007). Sex and HIV education programs: Their impact on sexual behaviors of young people throughout the world. The Journal of Adolescent Health, 40, 206–217.PubMedCrossRefGoogle Scholar
  53. Klein, S. J., Candelas, A. R., Cooper, J. G., Badillo, W. E., Tesoriero, J. M., et al. (2008). Increasing safe syringe collection sites in New York State. Public Health Rep, 123, 433–440.Google Scholar
  54. Klein, S. J., Karachner, W. D., & O’Connell, D. A. (2002). Interventions to prevent HIV-related stigma and discrimination: Findings and recommendations for public health practice. Journal of Public Health Management and Practice, 8, 44–53.PubMedGoogle Scholar
  55. Klein, S. J., O’Connell, D. A., Devore, B. S., Wright, L. N., & Birkhead, G. S. (2002). Building an HIV Continuum for inmates: New York State’s criminal justice initiative. AIDS Education and Prevention, 14, 114–123.PubMedCrossRefGoogle Scholar
  56. Klein, J. D., Sesselberg, T. S., Gawronski, B., Handerwerker, L., Gestern, F., & Schetine, A. (2003). Improving adolescent preventive services through state, managed care, and community partnerships. The Journal of Adolescent Health, 32, 91–97.PubMedCrossRefGoogle Scholar
  57. Knowlton, A., Arnsten, J., Eldred, L., Wilkinson, J., Gourevitch, M., et al. (2006). Individual, interpersonal, and structural correlates of effective HAART use among urban active injection drug users. Journal of Acquired Immune Deficiency Syndromes, 41, 486–492.PubMedCrossRefGoogle Scholar
  58. Koumans, E. H., Farley, T. A., Gibson, J. J., Langley, C., Ross, M. W., et al. (2001). Characteristics of persons with syphilis in areas of persisting syphilis in the United States: Sustained transmission associated with concurrent partnerships. Sexually Transmitted Diseases, 28, 497–503.PubMedCrossRefGoogle Scholar
  59. Krieger, N., Chen, J. T., Waterman, P. D., Rehkopf, D. H., & Subramanian, S. V. (2005). Painting a truer picture of U.S. socioeconomic and Racial/Ethnic health inequalities: The public health disparities geocoding project. American Journal of Public Health, 95, 312–323.PubMedCrossRefGoogle Scholar
  60. Latkin, C. A., Curry, A. D., Hua, W., & Davey, M. A. (2007). Direct and indirect associations of neighborhood disorder with drug use and high-risk sexual partners. American Journal of Preventive Medicine, 32, S234–S241.PubMedCrossRefGoogle Scholar
  61. Latkin, C. A., Williams, C. T., Wang, J., & Curry, A. D. (2005). Neighborhood social disorder as a determinant of drug injection behaviors: A structural equation modeling approach. Health Psychology, 24, 96–100.PubMedCrossRefGoogle Scholar
  62. Martin, S. S., Butzin, C. A., & Inciardi, J. A. (1995). Assessment of a multistage therapeutic community for drug-involved offenders. Journal of Psychoactive Drugs, 27, 109–116.PubMedCrossRefGoogle Scholar
  63. Massey, D. S., & Denton, N. A. (1993). American apartheid: Segregation and the making of the underclass. Cambridge, MA: Harvard University Press.Google Scholar
  64. May, J. P., & Williams, E. L. (2002). Acceptability of condom availability in a U.S. jail. AIDS Education and Prevention, 14, 85–91.PubMedCrossRefGoogle Scholar
  65. McCarty, D., LaPrade, J., & Botticelli, M. (1996). Substance abuse treatment and HIV services: Massachusetts’ policies and programs. Journal of Substance Abuse Treatment, 13, 429–438.PubMedCrossRefGoogle Scholar
  66. McKinnon J. (2003). The black population in the United States: March 2002. In Washington: U.S. Census Bureau (Ed.) Current Population Reports, Series P20-541.Google Scholar
  67. McLoyd, V. C., & Steinberg, L. (1998). Studying minority adolescents: Conceptual, methodological, and theoretical issues. Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
  68. Mertz, K. J., Schwebke, J. R., Gaydos, C. A., Beidinger, H. A., Tulloch, S. D., & Levine, W. C. (2002). Screening women in jails for chlamydial and gonoccocal infection using urine tests: Feasibility, acceptability, prevalence, and treatment rates. Sexually Transmitted Diseases, 29, 271–276.PubMedCrossRefGoogle Scholar
  69. Mofenson, L. M., & Centers for Disease Control and Prevention, U.S. Public Health Service Task Force. (2002). U.S. public health service task force recommendations for use of antiretroviral drugs in Pregnant HIV-1-infected women for maternal health and interventions to reduce Perinatal HIV-1 TRANSMISSION in the United States. MMWR: Recommendations and Reports, 51, 1–38.PubMedGoogle Scholar
  70. Molitor, F., Kuenneth, C., Waltermeyer, J., Mendoza, M., Aguirre, A., et al. (2005). Linking HIV-infected persons of color and injection drug users to HIV medical and other services: The California bridge project. AIDS Patient Care, 19, 406–412.CrossRefGoogle Scholar
  71. Nakashima, A. K., Horsley, R., Frey, R. L., Sweeney, P. A., Weber, J. T., & Fleming, P. L. (1998). Effect of HIV reporting by name on use of HIV testing in publicly funded counseling and testing programs. The Journal of the American Medical Association, 280, 1421–1426.CrossRefGoogle Scholar
  72. Neaigus, A., Zhao, M., Gyarmathy, V. A., Cisek, L., Friedman, S. R., & Baxter, R. C. (2008). Journal of Urban Health, 85, 309–322.PubMedCrossRefGoogle Scholar
  73. Nicholas, S. W., Jean-Louis, B., Oritz, B., Northridge, M., Shoemaker, K., et al. (2005). Addressing the childhood asthma crisis in Harlem: The Harlem children’s zone asthma initiative. American Journal of Public Health, 95, 245–249.PubMedCrossRefGoogle Scholar
  74. Parkhurst, J. O. (2001). The crisis of AIDS and the politics of response: The case of Uganda. International Relations, 15, 69–87.CrossRefGoogle Scholar
  75. Potterat, J. J., Zimmerman-Rogers, H., Muth, S. Q., Rothenberg, R. B., Green, D. L., et al. (1999). Chlamydia transmission: Concurrency, reproduction number, and the epidemic trajectory. American Journal of Epidemiology, 150, 1331–1339.PubMedCrossRefGoogle Scholar
  76. Pronyk, P. M., Kim, J. C., Abramsky, T., Phetla, G., Hargreaves, J. R., Morison, L. A., et al. (2008). A combined microfinance and training intervention can reduce HIV risk behaviour in young female participants. AIDS, 22, 1659–1665.PubMedCrossRefGoogle Scholar
  77. Richie, B. E., Freudenberg, N., & Page, J. (2001). Reintegrating women leaving jail into urban communities: A description of a model program. Journal of Urban Health, 78, 290–303.PubMedCrossRefGoogle Scholar
  78. Rothman, J., Rudnick, D., Slifer, M., Agins, B., Heiner, K., & Birkhead, G. (2007). Co-located substance use treatment and HIV prevention and primary care services, New York State, 1990–2002: A model for effective service delivery to a high-risk population. Journal of Urban Health, 84, 226–242.PubMedCrossRefGoogle Scholar
  79. Rutherford, G. W., Woo, J. M., Neal, D. P., Rauch, K. J., Geoghegan, C., McKinney, K. C., et al. (1991). Partner notification and the control of human immunodeficiency virus infection. Two years of experience in San Francisco. Sexually Transmitted Diseases, 18, 107–110.PubMedCrossRefGoogle Scholar
  80. Schuler, S. R., & Hashemi, S. M. (1994). Credit programs, women’s empowerment, and contraceptive use in rural Bangladesh. Studies in Family Planning, 25, 65–76.PubMedCrossRefGoogle Scholar
  81. Sherman, S. G., German, D., Cheng, Y., Marks, M., & Bailey-Kloche, M. (2006). The evaluation of the JEWEL project: An innovative economic enhancement and HIV prevention intervention study targeting drug using women involved in prostitution. AIDS Care, 18, 1–11.PubMedCrossRefGoogle Scholar
  82. Stoneburner, R., & Low-Beer, D. (2004). Population-level HIV declines and behavioral risk avoidance in Uganda. Science, 302, 714–718.CrossRefGoogle Scholar
  83. Sumartojo, E. (2000). Structural and environmental factors in HIV prevention: Concepts, examples, and implications for research. AIDS, 14, S3–S10.PubMedCrossRefGoogle Scholar
  84. Sumartojo, E., Doll, L., Holtgrave, D., Gayle, H., & Merson, M. (2000). Enriching the mix: Incorporating structural factors in HIV prevention. AIDS, 14, S1–S2.PubMedCrossRefGoogle Scholar
  85. Sweat, M. D., & Denison, J. A. (1995). Reducing HIV incidence in developing countries with structural and environmental interventions. AIDS, 9, S251–S257.PubMedGoogle Scholar
  86. Swenson, R. R., Rizzo, C. J., Brown, L. K., Payne, N., DiClemente, R. J., et al. (2009). Prevalence and correlates of HIV testing among sexually active African American adolescents in 4 US cities. Sex Transm Dis, 36, 584–591.Google Scholar
  87. Towe, V. L., Sifakis, F., Gindi, R. M., Sherman, S. G., Flynn, C., et al. (2010) Prevalence of HIV Infection and Sexual Risk Behaviors Among Individuals Having Heterosexual Sex in Low Income Neighborhoods in Baltimore, MD: The BESURE Study. JAIDS Journal of Acquired Immune Deficiency Syndromes, 53, 522–528.Google Scholar
  88. U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Demographic trends in jail populations. Retrieved April 27, 2009 from
  89. US Census Bureau. (2003). Poverty: 1999. Census 2000 Brief. Retrieved April 27, 2009 from
  90. Vlahov, D., & Junge, B. (1998). The role of needle exchange programs in HIV prevention. Public Health Reports, 113, S75–S80.Google Scholar
  91. Watson, C. (1988). An open approach to AIDS. Africe Report, 33, 32–34.Google Scholar
  92. Wolfe, M. I., Xu, F., Patel, P., O’Cain, M., Schillinger, J. A., et al. (2001). An outbreak of syphilis in Alabama prisons: Correctional health policy and communicable disease control. American Journal of Public Health, 91, 1220–1225.PubMedCrossRefGoogle Scholar
  93. Wolitski, R. J., Kidder, D. P., & Fenton, K. A. (2007). HIV, homelessness, and public health: Critical issues and a call for increased action. AIDS and Behavior, 11, S167–S171.CrossRefGoogle Scholar
  94. Woods, W. J. (2003). Public health policy and gay bathhouses. Journal of Homosexuality, 44, 1–21.PubMedCrossRefGoogle Scholar
  95. Zenilman, J. M., Ellish, N., Fresia, A., & Glass, G. (1999). The geography of sexual partnerships in Baltimore: Applications of core theory dynamics using a geographic information system. Sexually Transmitted Diseases, 26, 75–81.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Division of General Pediatrics & Adolescent MedicineJohns Hopkins School of MedicineBaltimoreUSA

Personalised recommendations