''Circumstantial Determinants'': An Efficient Approach to Reaching People in Need of HIV Prevention?

The study examined a new approach to HIV prevention focused on circumstantial determinants – social circumstances, settings, and norms associated with risk-taking behavior. The research was conducted in Zimbabwe in 2018/19 on a sample of 9,141 individuals. Researchers identified HIV-negative individuals with risky sexual behavior as a priority population for prevention. For each sex, six circumstantial determinants were identified as being associated with this group. Findings show that targeting men in bars and beerhalls could reach 48.5% of the priority population. If targeting was expanded to men with poor mental health, no religious affiliation, or living on agricultural estates, reach would increase to 77.1%. For women, targeting those with poor mental health reached 32.0% of the priority population, with expansion to additional determinants increasing reach to 54.1%. The Circumstantial Determinants approach demonstrates potential to strengthen HIV prevention services.