Online Program

A four-value structural framework for HIV Prevention and treatment

Tuesday, November 3, 2015

Salaam Semaan, DrPH, National Center for HIV/AIDS, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
Mary Neumann, PhD, Division of HIV/AIDS, CDC, Atlanta, GA
Mary Leinhos, Phd, Office of Public Health Preparedness and Response, CDC, Atlanta, GA
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.

Learning Areas:

Clinical medicine applied in public health
Ethics, professional and legal requirements
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy
Public health or related research

Learning Objectives:
Describe frameworks and terms that are structural and value-laden that influence HIV prevention and treatment. Discuss concrete research, practice, and policy interventions in HIV prevention and treatment. Apply, evaluate, and assess a parsimonious framework that can be applied to address or resolve structural factors and values that affect HIV or other infections and diseases.

Keyword(s): HIV/AIDS, Human Rights

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have extensive years of experience, work at CDC, and educational background providing me with outstanding expertise
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4277.0: HIV Testing & Care