Potential Impact and Resource Needs
The CDC has established the goal of reducing new HIV infections in the United States by 50% in 4 years.44 We estimate that to reach that goal, it is critical to increase by 30,000 each year the number of infected people who become aware of their serostatus and are linked to appropriate care and prevention services. In addition, full and appropriate prevention services must be provided for all individuals with HIV infection. These activities will require an additional public investment of $300 million per year. These additional resources would be directed at (a) a highly targeted HIV counseling and testing effort to identify undiagnosed HIV-seropositive persons, provide expanded voluntary testing, and develop and implement effective referrals to prevention and care services; (b) comprehensive HIV prevention services for each seropositive person whose ongoing behavior could lead to HIV transmission; and (c) HIV prevention services such as counseling for high-risk HIV-seronegative clients identified through the counseling and testing effort, particularly current partners of HIV-infected individuals. Increasing the number of individuals with HIV who know their status will increase the number in care and will require increases in public financing for care through Medicaid and the Ryan White CARE Act.
Such an investment will save not only lives but money. Given that in 1997 each averted HIV infection saved society approximately $154,000 in discounted lifetime treatment costs of HIV disease,60 an additional $300 million would have to avert only about 2000 HIV infections to produce these cost savings. Preliminary modeling analyses, based on literature on the effectiveness of behavioral intervention, suggest that SAFE programs might actually avert approximately 20% of HIV infections (8,000 cases) per year (CDC, unpublished data, 2000). Thus, maintaining current prevention programs for high-risk uninfected persons and fully implementing the CDC's SAFE initiative could reduce HIV incidence by nearly 60% (approximately 23,000 cases) and reduce the number of HIV-infected people with unknown serostatus by 80% in 4 years.