POLICIES FOR CURBING THE HIV EPIDEMIC IN THE UNITED-STATES - IMPLICATIONS OF A SIMULATION-MODEL

An 8-compartment simulation model, with monthly steps and with differe nt infectivities for 4 pre-AIDS phases of HIV, simulates the U.S. epid emic from 1976-2005. The use of AZT or other antiretroviral drugs is i ntroduced under the assumptions that it halves the mte of conversion t o AIDS, and that, with behavior change, it reduces transmission coeffi cients by 2/3. Two policy scenarios are projected. They assume that 66 and 100% of HIV-infected persons whose CD4 count is less than 500 are identified by voluntary testing and are treated with AZT by the end o f 1993-which might be approached with full subsidy of medical treatmen t and protection against discrimination. Without such policies, we pro ject over 100,000 new AIDS cases and 110,000 HIV infections in 2005, a nd a $14 billion annual cost. Maximum use of AZT could reduce these nu mbers to 50,000, 45,000 and $10 billion, respectively. Such policies m ight draw support from the infected, the uninfected, economizing offic ials and pharmaceutical companies.