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Bleach programs for preventing AIDS among IV drug users: Modeling the impact of HIV prevalence

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  • Siegel, J.E.
  • Weinstein, M.C.
  • Fineberg, H.V.

Abstract

Background. The growing importance of drug use as a mode of HIV transmission has led to increased attention to AIDS prevention among intravenous drug users (IVDUs). This analysis examines the effectiveness of bleach distribution, a program to prevent HIV transmission via shared needles. Methods. We used a Markov model to assess the role of the initial HIV prevalence among drug users in determining the effectiveness of bleach programs. The model incorporates survey data on risk behaviors and published information describing HIV incubation and mortality. It predicts life expectancy for cohorts of IVDUs with and without a bleach program to estimate program effectiveness. Results. We found that bleach programs can produce the greatest life-year savings in areas of low HIV prevalence. In the lowest prevalence scenario (0.02 initial prevalence), initiation of the program resulted in a projected savings of 2.3 life years per HIV-negative drug user, compared with 1.7 and 1.3 years under medium (0.25) and high (0.60) prevalence, respectively. Conclusions. While bleach programs are beneficial in all groups of IVDUs, these results highlight the advantages of introducing bleach programs early, when prevalence is still comparatively low in a drug-user population.

Suggested Citation

  • Siegel, J.E. & Weinstein, M.C. & Fineberg, H.V., 1991. "Bleach programs for preventing AIDS among IV drug users: Modeling the impact of HIV prevalence," American Journal of Public Health, American Public Health Association, vol. 81(10), pages 1273-1279.
    • Handle: RePEc:aph:ajpbhl:1991:81:10:1273-1279_4
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    Cited by:

    1. James G. Kahn & Margaret L. Brandeau & John Dunn-Mortimer, 1998. "OR Modeling and AIDS Policy: From Theory to Practice," Interfaces, INFORMS, vol. 28(3), pages 3-22, June.
    2. Gregory S. Zaric & Margaret L. Brandeau & Paul G. Barnett, 2000. "Methadone Maintenance and HIV Prevention: A Cost-Effectiveness Analysis," Management Science, INFORMS, vol. 46(8), pages 1013-1031, August.
    3. Zoë K. Harris, 2006. "Efficient allocation of resources to prevent HIV infection among injection drug users: the Prevention Point Philadelphia (PPP) needle exchange program," Health Economics, John Wiley & Sons, Ltd., vol. 15(2), pages 147-158, February.
    4. Steven D. Pinkerton & Harrell W. Chesson & David R. Holtgrave & William Kassler & Peter M. Layde, 2000. "When is an HIV Infection Prevented and when is it Merely Delayed?," Evaluation Review, , vol. 24(3), pages 251-271, June.
    5. Martin A. Andresen & Ehsan Jozaghi, 2012. "The Point of Diminishing Returns: An Examination of Expanding Vancouver’s Insite," Urban Studies, Urban Studies Journal Limited, vol. 49(16), pages 3531-3544, December.

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