A four-value structural framework for HIV Prevention and treatment

background: Thirteen principle-based, human rights, and social justice frameworks, encompassing 45 values, are used to understand structural factors affecting public health research, practice, and policy. Overlapping frameworks and terms made us suggest one framework of four values—liberty, equality, efficiency (impact/outcome achievement), and community.

methods: To assess and comparre convergence in frameworks and values, we applied our framework to HIV prevention and treatment, choosing one example each from research, program, and policy. We grouped factors in each example into one of four values.

results: Factors influencing respondent-driven sampling, through participant-driven recruitment to research, include concerns about coercing peers into recruitment (liberty), using remuneration for unhealthful behaviors (efficiency), and investigators’ responsibility for informing partners of HIV discordant test results (efficiency). Factors influencing prevention and control of bacterial STDs, through partner-delivered therapy, include threats to privacy and confidentiality (liberty), responsibility of clinicians for medications provided to partners without medical evaluation (efficiency), potential side effects of medications provided to partners without medical evaluation (equality), and stability of partnerships (community). Factors influencing the routine universal HIV testing policy include opportunities for verbal opt-out (liberty), prevention and treatment benefits (efficiency), and benefits of reducing stigma of testing and disease (efficiency).

conclusions: Prevention and treatment of HIV or other diseases require us to understand underlying structural factors and values. Using a four-value framework offers similar analytic power to lengthy frameworks and does so more directly, incisively, and quickly. Parsimonious grouping of values can facilitate identification and analysis of conflicts and implementation of public health strategies.