Australia: Needle Schemes Stop Thousands of HIV Cases

Australia's pioneering syringe exchange programs have prevented 25,000 new HIV infections and 21,000 hepatitis C infections in just 10 years, according to the Return on Investment in Needle Exchange and Syringe Programs Report released today at the HIV Medicine conference in Sydney. By 2010, it is projected that needle exchange will have prevented 4,500 AIDS-related deaths throughout Australia, saving an estimated $2.4 billion (US $1.3 billion) in public health funding.

The research, commissioned by the Commonwealth, analyzed 778 years of data from 103 cities worldwide, comparing HIV and hepatitis C infection among injecting drug users in countries with and without needle and syringe programs (NSPs). These data were then used to calculate the return on investment from NSPs in Australia from 1991 to 2000, providing potent, measurable evidence of the benefits of one of Australia's most controversial public health policies. The report's findings include:

• Cities with NSPs had an average annual 18.6 percent decrease in HIV prevalence compared with an average annual 8.1 percent increase in cities that did not introduce NSPs.

• In Australia, between 1991 -- when they were running in all states except Tasmania -- and 2000, NSPs have cost federal and state governments $130 million (US $71.8 million).

• From this 10-year investment, public health savings of $2.4 billion (US $1.3 billion) were estimated in long-term HIV and hepatitis C treatment costs alone (allowing for conventional government discounting of 5 percent). The savings were estimated at $7.7 billion (US $4.2 billion) without discounting.
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• By 2010, NSPs will have prevented 90 deaths from hepatitis C.

For HIV, this was calculated on the 25,000 avoided cases, an average lifespan of 24 years after infection, and treatment cost of nearly $14,000 (US $7,700) for each year of life after diagnosis. Annual HIV treatment costs for the cases avoided are projected to reach a peak of $269 million (US $148.6 million) by 2008 as patients reach later stages of the disease. Annual treatment costs for hepatitis C cases avoided are projected to reach $18.8 million (US $10.4 million) by 2040 and decline thereafter. The costs are high despite the relatively low numbers because of the potential for progression to liver failure and the high costs of treatment.

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