Autores: Stefano M Bertozzi, Juan-Pablo Gutiérrez
Publicado en: The Lancet Global Health
The paper by Lucie Cluver and colleagues in this month’s issue of The Lancet Global Health1 is an important piece of evidence in a sparsely populated field: rigorous evaluation of the impact of interventions that seek to modify the underlying structural determinants of HIV transmission. Almost since the beginning of the epidemic we have been hypothesising about the structural determinants of HIV transmission. Countless pages have been written about the effect of factors such as poverty, marginalisation, human rights abuses, and the status of women on the transmission of HIV. Improving any of those domains is good, in and of itself. We should not need an HIV justification to improve the status of women. Partly because of this sentiment, there has often been an implicit resistance to rigorous evaluation of the effect of structural interventions on HIV incidence: how could anyone be against improving the status of women? A woman who cannot control the circumstances under which she has sex will obviously be at higher risk of HIV infection, therefore why should we waste time and money measuring the impact on HIV of interventions to improve the status of women?