People Do not Live in Programmes: Rethinking HIV Health Promotion in a Fluid and Intersecting World

Abstract

HIV health promotion has often been organized through programmes that address specific populations, behaviours, risks, or health outcomes. While this approach has contributed significantly to the expansion of HIV prevention and treatment, it can also overlook the complexity and fluidity of people’s everyday lives. People do not experience their lives through separate programmes. They live one life in which health, sexuality, gender, relationships, work, economic circumstances, social environments, stigma, mobility, and access to services intersect and change over time.

This perspective argues that HIV health promotion needs to move beyond programme-based thinking towards approaches that recognize people as whole and evolving human beings. Drawing on community experiences and reflections from HIV and community health work, the article explores how intersecting identities and changing life circumstances influence people’s engagement with health services and prevention interventions. It highlights the limitations of fragmented systems in which individuals are expected to navigate multiple programmes, eligibility criteria, service providers, and forms of support separately.

The article proposes a shift from asking which programme a person belongs to towards asking what matters in that person’s life at a particular moment. Such a shift requires health systems to become more flexible, person-centred, community-informed, and responsive to changing needs. Integrating HIV health promotion with broader wellbeing, social support, rights, and community systems may create more meaningful pathways to health and dignity.

Ultimately, people do not live in programmes; they live one life. If people’s lives are fluid, interconnected, and constantly changing, health systems must also become capable of responding to the whole person rather than to isolated categories or programme boundaries.