Abstinence Reduces HIV For High-Risk Women - Even Those Who Relapse - St...( success is highest among a targeted gr...),Health

success is highest among a targeted group of intravenous drug users. The researchers modeled a group of 10,000 intravenous drug using women over a two-year period. If there are 25% relapses to risky behavior during the period, there would be prevention of 1 infection in infants, 72 infections in adults, and $16 million in savings. If relapses climbed to 50%, there would still be prevention of 1 infection in infants, 66 infections in adults, and $11.8 million in savings.

In contrast, a perfect success rate without relapses would prevent 1 infection in infants, prevent 78 infections in adults, and save $19.9 million in earnings and medical expenses.

The rate of success is slightly diminished in the second group (women who are intravenous drug users and women who have high risk sexual partners), whose members' risk of infection is lower.

The study analyzes data from an earlier study in California by the authors. Based on previous findings, it assumes that, on average, counseling and testing result in an initial 15% reduction in risky behavior. The authors used operations research techniques in their analysis, including a dynamic model of the HIV epidemic and an economic model that assesses the costs and benefits. The authors found that programs aimed at the third group -the entire population of women - require a greater degree of behavior change in to achieve cost effectiveness. Initial rates of change in behavior must be as high as 23% if the expense reaching out to such a large group is to be cost-effective.

Glass Half Full, Not Half Empty

The study offers a significant conclusion: "Counseling and testing need not eliminate risk behaviors totally, nor produce permanent reductions in risk behaviors; even interventions short of this ideal will provide benefits that outweigh their costs."

Nevertheless, the authors caution, " Our study underscores the critical importance of developing behavioral interventions that produce sustained reductions
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Contact: Barry List
barry.list@informs.org
410 691-7852
Institute for Operations Research and the Management Sciences
17-Jun-1998

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