Researchers at Johns
Hopkins Bloomberg School of Public Health have
conducted a historical analysis to examine the relationship
between the Centers for Disease Control and Prevention's
HIV prevention budget and HIV incidence in the United
States from 1978 to 2006. The results are published in the
January edition of the American Journal of Preventive
The researchers found that from the beginning of the
epidemic until 1985, when new infections peaked, incidence
of HIV predicted investment levels. During this period,
society responded to increasing levels of infection with
more investment in prevention programs.
Things changed in the mid-1980s, when investment
levels began to predict incidence; that is, as the nation
continued to increase the funding of HIV prevention
programs, HIV dropped substantially from 160,000 to about
40,000 infections per year.
In the early 1990s, as the level of investment
(adjusted for inflation) flattened out with little annual
change, so, too, did the number of new infections per year.
This suggested to the researchers that level investment
yields level incidence.
"Our analysis helps explain why the number of new HIV
infections has remained at 40,000 per year for over 15
years," said David R. Holtgrave, chair of the
Health, Behavior and Society at the Bloomberg School and
lead author of the study. "Investment levels have predicted
HIV incidence since the mid-1980s. If we want to lower
infections further in the U.S., these analyses suggest we
should consider increasing our national investment. Yes,
that may seem expensive, but HIV medical care easily tops
$20,000 per patient per year. Therefore, funding of
effective, scientifically sound HIV prevention services is
likely to have a very favorable return on investment in
terms of both lives and dollars saved."
Holtgrave noted that the analysis was based on
historical data and is not a prospective trial of
prevention effectiveness. Therefore, it is subject to
methodological limitations. Nevertheless, he said, it
provides substantial indications of a strong relationship
between the amount of national investment in HIV prevention
and levels of new infections per year in the country.
The paper was co-authored by Jennifer Kates, of the
Kaiser Family Foundation.