AIDS prevention efforts across the United States, including programs to promote the use of condoms and focus groups aimed at drug users, have saved hundreds of thousands of lives, researchers said on Friday. Although the number of new infections has stayed level at about 40,000 a year for the past decade, many more people would have become infected with AIDS if prevention programs had not been in place, according to the report.

"We have prevented enough HIV infections to be the equivalent of the population of a small to large US city," said David Holtgrave, an AIDS expert formerly at the CDC who now teaches health policy at Emory University in Atlanta.

It was not hard to find out what would happen without AIDS prevention efforts. Most HIV cases are in African countries too poor to do much to control the virus. Holtgrave looked at infection rates in those countries and also looked at theoretical scientific models of epidemics. He came up with four different scenarios for the course of the AIDS epidemic in the United States. The number of potential infections prevented ranged from 200,000 to more than 1.5 million, Holtgrave wrote. The full report, "Estimating the Effectiveness and Efficiency of US HIV Prevention Efforts Using Scenario and Cost-effectiveness Analysis," was published in AIDS (2002;16(17);2347-2349).

Most prevention programs target the estimated 5 million Americans thought to be at risk of HIV through injection drug use or sex. A greater commitment is needed, however. "To really give everybody at risk of HIV infection in the United States really state-of-the-science prevention services, you would probably need to increase prevention efforts by $300 million a year for four years," Holtgrave said. "We're not seeing that kind of expansion." The government's current budget provides no more money for HIV prevention than last year's, Holtgrave said.

If 200,000 deaths have been prevented, Holtgrave estimates it costs about $50,000 to prevent each infection, versus $150,000 to $195,000 to treat someone for HIV for the rest of their life. If the actual number of infections prevented were closer to his top estimate of 1.5 million, then the cost per infection prevented would be around $6,400. "These analyses do not include other real benefits of prevented HIV infections such as increased worker productivity and decreased pain and suffering," Holtgrave said.

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