The structural approach of HIV prevention : the case of female sex workers in Honduras

The goal of this report was to assess current prevention strategies that attempt to reduce HIV prevalence among female sex workers (FSW) in Honduras. This analysis was based on the difference between behavioral change and structural approaches; that is, while behavioral change theories are based on risk reduction through promoting individuals’ change, the structural approach addresses the factors in the environment that make individuals vulnerable to HIV. In order to analyze prevention strategies in Honduras, I carried out an analysis of the structural conditions at the country level and, at the sex workers population level. The structural factors that make Honduras a country vulnerable to HIV are political instability, migrations, poverty and socio-economic conditions, and gender inequality. As a consequence of those macro-environmental conditions, sex workers face the following micro-environmental factors that increase their vulnerability to HIV: violence and male domination; large families and single parenthood; low income and poor education; and public policies against sex work, such as police abuse and closure of brothels. This report is based on an analysis of the Sonagachi Project in India, 100% Condom Use in Thailand, and the intervention in the Dominican Republic, programs that successfully address structural conditions and decrease women’s vulnerability to HIV. This report showed that in Honduras, the prevention strategies currently implemented are limited because they are based on behavioral change theories, failing to address environmental barriers that increase vulnerability to HIV among FSW. I give some specific recommendations about how to improve prevention strategies in this country reducing women’s vulnerability by addressing the structural factors they face.