Greater Prevention Efforts Could be Cure for Rising Cost of HIV Treatment

A greatly expanded HIV-prevention program could pay for itself by averting unnecessary medical expenses, according to a new study.

Although the annual number of newly diagnosed HIV cases dropped dramatically from about 160,000 cases in the mid-1980s to about 40,000 in 1990, the number has remained largely unchanged for the past decade. The consistent number of yearly infections suggests that substantial, unmet HIV prevention needs continue to fuel the epidemic in the United States, according to the study in the July issue of the American Journal of Preventive Medicine.

The cost of HIV prevention services to address unmet HIV prevention needs ranges widely depending on the complexity of the services offered. The authors determined that if relatively brief interventions are used to address sexual behavior risks, total program costs are slightly more than $817 million. If more expensive small-group interventions are used, the costs increase to more than $1.85 billion. This compares with the $412 million spent by the Centers for Disease Control and Prevention on service programs in fiscal year 1999.

Lead author David R. Holtgrave, Ph.D., of the Rollins School of Public Health at Emory University, states that if the U.S. government intends to achieve its announced national goal of reducing the annual number of new HIV infections by 50 percent by 2005, additional resources will be required.

"While much appropriate attention has recently been given to resource needs for HIV/AIDS programs in developing countries, little attention has been previously given to unmet domestic HIV-prevention needs," the researchers note. "Hopefully, the analysis presented here provides information to fill that important knowledge gap."

Holtgrave and his colleagues at the Medical College of Wisconsin and Yale University identified a range of interventions needed to reduce behavior risks, such as providing access to sterile syringes for people who cannot stop injecting drugs, HIV counseling and tests and intensive preventive services to help HIV-positive individuals avoid transmitting the virus to others.

In reviewing past literature, the authors found that community-level and multi-session small group approaches to reduce risky sexual behaviors have been determined to be particularly effective. Other types of interventions found effective include one-session group interventions and short video-based interventions. It is important that people engaged in risky behaviors know their viral status, the authors say, making counseling and testing services more critical, as well as important potential tools to change behavior and prevent HIV infection.

The added expenditures to address unmet HIV prevention needs may appear large, Holtgrave said, but he and the other researchers determined that only 5,300 to 12,000 new infections -- out of the 40,000 seen each year in the United States -- would have to be prevented in order to save money that is currently spent on medical expenses.

Funding for the research was provided by the Centers for AIDS Research at Emory University, Center for AIDS Intervention Research at the Medical College of Wisconsin and the Center for Interdisciplinary Research at Yale University.