AN OPPORTUNITY LOST - HIV-INFECTIONS ASSOCIATED WITH LACK OF A NATIONAL NEEDLE-EXCHANGE PROGRAM IN THE USA

Background Our aim was to estimate the number of HIV infections that c ould have been prevented had needle-exchange programmes been implement ed during the early stages of the AIDS epidemic in the USA. We also es timated the cost to the US health-care system to treat these preventab le HIV infections. Methods 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 tran smission to injection drug users (IDUs) and secondary transmission to their sexual partners and children. Data for the model were obtained f rom epidemiological and mathematical studies in peer-reviewed publishe d research, government reports, and consultations with experts. Using data from Australia as a model, we calculated the number of HIV infect ions that could have been prevented by a national needle-exchange prog ramme in the USA between 1987 and 1995. Cost calculations were based o n the current US government estimate of the discounted lifetime cost o f treating an HIV infection (US$55 640). Findings Our conservative cal culation of the number of HIV infections that could have been prevente d ranged from 4394 (15% incidence reduction due to needle exchanges) t o 9666 (33% incidence reduction). The cost to the US health-care syste m of treating these preventable HIV infections is between US$ 244 mill ion and US$ 538 million, respectively. If current US policies are not changed. we estimate that an additional 5150-11 329 preventable HIV in fections could occur by the year 2000. Interpretation The failure of t he federal government in the USA to implement a national needle-exchan ge programme, despite six government-funded reports in support of need le exchanges, may have led to HIV infection among thousands of IDUs, t heir sexual partners, and their children. Revoking the US government b an on funding for needle-exchange programmes and accelerating the grow th of such programmes in the USA are urgent public-health priorities.