This document presents information on how young people in southern and eastern Africa remain disproportionately vulnerable to HIV with gender inequalities and livelihood insecurities being key drivers of this. Behavioural HIV prevention interventions have had weak outcomes and a new generation of structural interventions have emerged seeking to challenge the wider drivers of the HIV epidemic, including gender inequalities and livelihood insecurities. We searched key academic data bases to identify interventions that simultaneously sought to strengthen people's livelihoods and transform gender relationships that had been evaluated in southern and eastern Africa. Our initial search identified 468 articles. We manually reviewed these and identified nine interventions that met our criteria for inclusion. We clustered the nine interventions into three groups: microfinance and gender empowerment interventions; supporting greater participation of women and girls in primary and secondary education; and gender empowerment and financial literacy interventions. We summarise the strengths and limitations of these interventions, with a particular focus on what lessons may be learnt for young people.
- Our review identified three major lessons for structural interventions that sought to transform gender relationships and strengthen livelihoods: 1) interventions have a narrow conceptualisation of livelihoods; 2) there is limited involvement of men and boys in such interventions; 3) studies have typically been done in stable populations.
- A new generation of HIV prevention interventions has purposefully moved away from narrowly targeting individual's knowledge and attitudes to recognizing how social contexts shape poor health and wellbeing, and attempting to modify these to enable behaviour change that leads to HIV prevention that the broad economic constraints on men and women are linked into wider processes of global change, capitalism and state policies.
- The interventions reviewed do nothing to challenge these wider issues, which underlie economic inequality. Yet, while challenging these broader processes is critical, such work will take a long time to achieve and at the same time, smaller structural interventions are required to ameliorate the worst impacts of these.