June 9, 2003

Missing HIV goal could cost U.S. $18 billion

By Tia Webster

Failure to reduce new HIV infections in the United States by 50 percent in the next two years not only will have substantial human consequences—it could cost the nation more than $18 billion.

A study by Rollins School of Public Health professor David Holtgrave analyzed the fiscal implications of the failure to meet this national goal set by the CDC in January 2001. The results are published in the June issue of the Journal of Acquired Immune Deficiency Syndrome.

Based on a cost analysis by Holtgrave, professor of behavioral science and health education, the failure to reduce new HIV infections by 50 percent by 2005 in the United States would result in 130,000 additional HIV infections between now and 2010, causing incurred net medical costs to grow to more than $18 billion during the same time frame. Holtgrave and Steven Pinkerton of the Medical College of Wisconsin say the human and fiscal stakes of meeting the CDC’s national HIV prevention goal are large enough to make it a top public health priority.

The CDC’s fiscal year 2002 domestic HIV prevention budget totaled approximately $692 million. Studies have determined that an estimated $300 million to $334 million in additional resources would be needed for each of the following four fiscal years to reduce new infections by 50 percent.

The resources could be used to expand HIV counseling and testing, behavioral risk reduction services for persons at risk of HIV infection through sexual or substance abuse, and intensive prevention services for persons already living with HIV infection. Assuming that the investment in such programs could hold down new infections to no more than 20,000 per year, Holtgrave said, the United States could save $18.45 billion through 2010.

For the past decade, however, the rate of new infections in the United States has remained largely unchanged at about 40,000 per year, and as of September 2002, the estimated number has not been modified by the CDC. Moreover, recent epidemiologic studies have shown increases of HIV-related risk behaviors and STDs in some communities. Given those factors, the researchers wrote, “It does appear a real possibility that the national HIV prevention goal might not be met by 2005.”

“Many people been somewhat burned out by HIV prevention messages,” Holtgrave said. “So too has our national investment in HIV prevention. Major, immediate expansions of science-based HIV prevention efforts are sorely needed to achieve the goal of reducing new HIV infections by 50 percent. Unfortunately, the time for
meeting the 2005 goal is fast running out.”

The paper was partially supported by the Emory Center for AIDS Research and a grant from the National Institute of Mental Health to the Medical College of Wisconsin.