Structural factors affecting women's HIV risk: a life-course example.

AIDS and HIV incidence among women continues to escalate in the United States and globally. While several behavior-change interventions have shown promise in helping some women to reduce their risk of HIV infection, numerous barriers continue to prevent many at-risk women from protecting themselves effectively. This paper explores structural interventions that may influence women's HIV risk directly or indirectly. We present the life course of Bobbie, a quasi-hypothetical woman whose circumstances and behaviors are based on those of a woman with whom the first author worked in an HIV risk-reduction program. Her circumstances also reflect those of numerous women who have become infected with HIV. Bobbie's risk-enhancing life events are presented chronologically and, at each step, structural interventions are described that might have had the potential to prevent movement to the next stage. Thus, each stage represents a 'missed opportunity' for employing social and societal interventions to prevent movement along the trajectory leading to HIV infection.