title: Evaluating social outcomes of HIV/AIDS interventions: a critical assessment of contemporary indicator frameworks.
abstract: BACKGROUND
  Contemporary HIV-related theory and policy emphasize the importance of addressing the social drivers of HIV risk and vulnerability for a long-term response. Consequently, increasing attention is being given to social and structural interventions, and to social outcomes of HIV interventions. Appropriate indicators for social outcomes are needed in order to institutionalize the commitment to addressing social outcomes. This paper critically assesses the current state of social indicators within international HIV/AIDS monitoring and evaluation frameworks.
  
  
  METHODS
  We analyzed the indicator frameworks of six international organizations involved in efforts to improve and synchronize the monitoring and evaluation of the HIV/AIDS response. Our analysis classifies the 328 unique indicators according to what they measure and assesses the degree to which they offer comprehensive measurement across three dimensions: domains of the social context, levels of change and organizational capacity.
  
  
  CONCLUSIONS
  The majority of indicators focus on individual-level (clinical and behavioural) interventions and outcomes, neglecting structural interventions, community interventions and social outcomes (e.g. stigma reduction; community capacity building; policy-maker sensitization). The main tool used to address social aspects of HIV/AIDS is the disaggregation of data by social group. This raises three main limitations. Indicator frameworks do not provide comprehensive coverage of the diverse social drivers of the epidemic, particularly neglecting criminalization, stigma, discrimination and gender norms. There is a dearth of indicators for evaluating the social impacts of HIV interventions. Indicators of organizational capacity focus on capacity to effectively deliver and manage clinical services, neglecting capacity to respond appropriately and sustainably to complex social contexts.
  
  
  CONCLUSIONS
  Current indicator frameworks cannot adequately assess the social outcomes of HIV interventions. This limits knowledge about social drivers and inhibits the institutionalization of social approaches within the HIV/AIDS response. We conclude that indicator frameworks should expand to offer a more comprehensive range of social indicators for monitoring and evaluation and to include indicators of organizational capacity to tackle social drivers. While such expansion poses challenges for standardization and coordination, we argue that the complexity of interventions producing social outcomes necessitates capacity for flexibility and local tailoring in monitoring and evaluation.
authors.affiliation: Department of Social Psychology, London School of Economics and Political Science, London, UK; j.c.mannell@lse.ac.uk.
authors.forename: Jenevieve
authors.initials: J
authors.lastname: Mannell
authors.affiliation: Department of Methodology, London School of Economics and Political Science, London, UK.
authors.forename: Flora
authors.initials: F
authors.lastname: Cornish
authors.affiliation: International HIV/AIDS Alliance, Brighton, UK.
authors.forename: Jill
authors.initials: J
authors.lastname: Russell
mesh_terms: D001521:Behavior Therapy; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control* / Q000523:psychology; D006302:Health Services Research; D006801:Humans; D012931:Social Environment; D016896:Treatment Outcome
keywords: HIV/AIDS; indicators; monitoring and evaluation; social drivers; social outcomes; structural interventions