Structural intervention approaches for HIV prevention work to remove social barriers to the use of HIV prevention services and promote the adoption of behaviours that reduce the risk of HIV transmission. These approaches act at the health policy level to support the delivery of HIV prevention tools; at the health systems level to support the integration of HIV prevention with other health services; and at the community level to promote of critical enabler interventions, such as peer-based community empowerment programmes developed through safe spaces often physically within health facilities. They also take the form of policy integration and resources with non-health sector structures that reach populations at risk in large numbers, such as in social development, education, microfinance/poverty alleviation. While there have been some evidence syntheses on the effectiveness of specific types of structural interventions, there is no review or summary of the evidence on the effectiveness of such interventions as a whole. This paper will provide a synthesis of the evidence on the effectiveness of structural interventions for HIV prevention, by providing a review of reviews of the literature with a discussion of the strength of the evidence from reviews and primary studies. The paper will summarise the key findings from these reviews with an aim to provide recommendations for the use of structural interventions for HIV prevention.
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