Important note: Information in this article was accurate in 2002. The state of the art may have changed since the publication date.

Reuters NewMedia - Monday, November 25, 2002
Maggie Fox, Health and Science Correspondent

Although the number of new infections has stayed level at about 40,000 a year for the past decade, many more people would have become infected with the AIDS virus if prevention programs had not been in place, the researchers said.

"We have prevented enough HIV infections to be the equivalent of the population of a small to large U.S. city," David Holtgrave, a former AIDS expert at the U.S. Centers for Disease Control and Prevention who now teaches health policy at Emory University in Atlanta, said in a telephone interview.

It was not hard to find out what would happen without AIDS prevention efforts. Most HIV cases are in Africa, in countries too poor to do much at all to control the deadly and incurable virus.

Holtgrave looked at infection rates in those countries and also looked at theoretical scientific models of epidemics.

He came up with four different scenarios for the course of the AIDS epidemic in the United States. The number of potential infections prevented ranged from 200,000 to more than 1.5 million, he wrote in his report, published in the journal AIDS.

"That's a broad range, but it reflects that there is no certainty," he said.

An estimated 5 million Americans are at risk of getting HIV -- 1 million drug users, who can be infected from shared needles, and 4 million men and women at risk of being infected sexually.

Most prevention programs target these groups. "They include HIV counseling and testing, risk reduction counseling and small group risk reduction interventions," Holtgrave said.

"For example, you get six or so people together and talk about how HIV is transmitted and how people can protect themselves."

GOVERNMENT NOT SPENDING MORE

To keep up this level of effort would require more money, but the government is not spending more, Holtgrave said.

"To really give everybody at risk of HIV infection in the United States really state-of-the-science prevention services, you would probably need to increase prevention efforts by $300 million a year for four years," he said.

"We're not seeing that kind of expansion."

The current budget provides no more money than last year for HIV prevention efforts, Holtgrave said.

This makes little sense as it costs much less to prevent HIV than to treat it, Holtgrave and other experts say.

If 200,000 deaths have been prevented, Holtgrave estimates it costs about $50,000 to prevent each infection, versus $150,000 to $195,000 to treat someone for HIV for the rest of his or her life.

If the actual number of infections prevented were closer to his top estimate of 1.5 million, then the cost per infection prevented would be around $6,400.

"These analyzes do not include other real benefits of prevented HIV infections such as increased worker productivity and decreased pain and suffering," Holtgrave said.

Worldwide 25 million people have died of AIDS. In the United States 450,000 have died of AIDS since the epidemic began in the early 1980s.

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