Addressing structural determinants of HIV risk

Many sex workers become involved in sex work while young, sometimes migrating from
rural areas to cities. Young migrants frequently move to the city to escape childhood
marriages or to assume responsibility for contributing to family income, sometimes as sole
providers. Measures are needed to prevent children and young people from being recruited
into sex work, including ensuring the availability of educational and work opportunities,
addressing family and social breakdown, increasing awareness of the health and other risks
associated with sex work, ensuring the availability of social protection safety nets (including
those required to mitigate the impacts of AIDS) and ensuring that all forms of child labour
are eliminated.
Addressing structural determinants of HIV risk and vulnerability is inevitably challenging,
as such approaches seek to alter complex and longstanding social, economic, political and
environmental factors80. While some may argue that structural interventions are too timeconsuming
or open-ended or that they divert resources from immediate HIV control
priorities, it is clear that the epidemic will not be reversed, nor will progress on HIV be
sustained, unless effective action is taken to address the structural factors that increase HIV
risk and vulnerability.