An opportunity lost: HIV infections associated with lack of a national needle-exchange programme in the USA.

Center for AIDS Prevention Studies, University of California, San Francisco 94105, USA.
The Lancet (Impact Factor: 39.21). 04/1997; 349(9052):604-8. DOI: 10.1016/S0140-6736(96)05439-6
Source: PubMed

ABSTRACT Our aim was to estimate the number of HIV infections that could have been prevented had needle-exchange programmes been implemented during the early stages of the AIDS epidemic in the USA. We also estimated the cost to the US health-care system to treat these preventable HIV infections.
The formula we used to calculate the annual number of preventable HIV infections accounted for the effectiveness and level of use of needle-exchange programmes, as well as sexual transmission to injection drug users (IDUs) and secondary transmission to their sexual partners and children. Data for the model were obtained from epidemiological and mathematical studies in peer-reviewed published research, government reports, and consultations with experts. Using data from Australia as a model, we calculated the number of HIV infections that could have been prevented by a national needle-exchange programme in the USA between 1987 and 1995. Cost calculations were based on the current US government estimate of the discounted lifetime cost of treating an HIV infection (US $55640).
Our conservative calculation of the number of HIV infections that could have been prevented ranged from 4394 (15% incidence reduction due to needle exchanges) to 9666 (33% incidence reduction). The cost to the US health-care system of treating these preventable HIV infections is between US $244 million and US $538 million, respectively. If current US policies are not changed, we estimate that an additional 5150-11329 preventable HIV infections could occur by the year 2000.
The failure of the federal government in the USA to implement a national needle-exchange programme, despite six government-funded reports in support of needle exchanges, may have led to HIV infection among thousands of IDUs, their sexual partners, and their children. Revoking the US government ban on funding for needle-exchange programmes and accelerating the growth of such programmes in the USA are urgent public-health priorities.

  • Source
  • Social work 10/2014; 59(4):363-5. DOI:10.1093/sw/swu027 · 1.15 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Smoking crack involves the risk of transmitting diseases such as HIV and hepatitis C (HCV). The current study determines whether the formerly unsanctioned supervised smoking facility (SSF)-operated by the grassroot organization, Vancouver Area Network of Drug Users (VANDU) for the last few years-costs less than the costs incurred for health-care services as a direct consequence of not having such a program in Vancouver, Canada. Methods: The data pertaining to the attendance at the SSF was gathered in 2012-2013 by VANDU. By relying on this data, a mathematical model was employed to estimate the number of HCV infections prevented by the former facility in Vancouver's Downtown Eastside (DTES). Results: The DTES SSF's benefit-cost ratio was conservatively estimated at 12.1:1 due to its low operating cost. The study used 70% and 90% initial pipe-sharing rates for sensitivity analysis. At 80% sharing rate, the marginal HCV cases prevented were determined to be 55 cases. Moreover, at 80% sharing rate, the marginal cost-effectiveness ratio ranges from $1,705 to $97,203. The results from both the baseline and sensitivity analysis demonstrated that the establishment of the SSF by VANDU on average had annually saved CAD$1.8 million dollars in taxpayer's money. Conclusions: Funding SSFs in Vancouver is an efficient and effective use of financial resources in the public health domain; therefore, Vancouver Coastal Health should actively participate in their establishment in order to reduce HCV and other blood-borne infections such as HIV within the non-injecting drug users.
    Harm Reduction Journal 11/2014; 11(1):30. DOI:10.1186/1477-7517-11-30 · 1.26 Impact Factor