March 3, 1997 Needle exchange programs could have
prevented nearly 10,000 HIV infections among injecting drug
users, their sex partners and their children in the United
States since 1987, according to a University of California
San Francisco study published in the March 1 issue of the
medical journal The Lancet. Expanding the Lancet study
data, the authors reported today (March 3) specific data
for 16 of the largest cities in the United States,
estimating that the number of preventable infections range
from 2,308 in New York City to 14 in Gary, Ind., for
198795. Treatment costs related to these infection rates
are calculated at $ 128,417,120 for New York City and $
778,960 for Gary.

Estimates of preventable HIV infection for other U.S.
cities are Atlanta, 186; Baltimore, 499; Boston, 182;
Chicago, 561; Dallas, 39; Detroit, 152; Houston, 260; Los
Angeles, 95; Miami, 297; Newark, N.J., 397; Philadelphia,
641; San Juan, PR, 315; Seattle, 48; and Washington, D.C.,
646.

If needle exchange programs (NEPs) were established
now, study coauthors say an additional 11,300 HIV
infections could be prevented in the United States by the
year 2000.

"Removing the U.S. government ban on NEP funding and
accelerating the growth of NEPs in the U.S. are public
health priorities as urgent as any in the HIV epidemic,"
stated coauthors Peter Lurie, M.D., MPH, a researcher at
the UCSF Center for AIDS Prevention Studies, and Ernest
Drucker, Ph.D., professor of epidemiology and social
medicine at Montefiore Medical Center/Albert Einstein
College of Medicine, New York. The team determined
estimates for both the Lancet study and the additional
analysis of the 16 cities based on a formula that accounted
for NEP effectiveness, how often injecting drug users use
NEPs, sexual transmission of the virus among them, and
secondary HIV transmission to their sex partners and
children. They obtained data from published
epidemiological and mathematical studies, government
reports and consultations with needle exchange
researchers and drug abuse experts.

As a model for their analysis, the researchers used the
Australian NEP system, which receives substantial
government support. Australia initiated a system of NEPs in
1987, early in the AIDS epidemic. By 1995, 50 percent of
Australian injecting drug users were receiving clean
needles through programs at least once a month.

Lurie and Drucker estimated that the number of HIV
infections that could have been prevented in the United
States by NEPs between 198795 is between 4,394 and 9,666,
depending on how effective NEPs are assumed to be. Of
these infections, 88 percent would have occurred among
injection drug users, with the remainder among their sex
partners and children, according to the study.

The researchers based cost calculations on the most
conservative estimate of the current lifetime cost of
treating an HIV infection $ 55,640 which does not
take into account treatment with the new, expensive
protease inhibitors. The cost of treating the preventable
HIV infections that occurred between 198795 ranges from $
244 million to $ 538 million, enough to have funded 161 to
354 NEPs, the study reports.

"There are now seven federal governmentfunded reports
concluding that NEPs can prevent HIV transmission without
increasing drug use," Drucker said, adding that he believes
study estimates are conservative. "Injection drug use is
the number one cause of HIV infection in the U.S.," Drucker
said.

By revoking laws that ban federal funding for NEPs, as
well as those state laws that impede pharmacy access to
sterile syringes, "we can still greatly reduce the number
of HIV infections that will otherwise occur possibly
preventing more than 11,000 additional HIV infections by
the year 2000 if we act now," Lurie said. 0

NOTE TO EDITORS: Media wishing to interview the
coauthors and to receive a copy of the study or
spreadsheets for one or more of the 16 cities should call
UCSF News Services, 415/4762557.

CONTACT: University of California, San Francisco Rebecca
Higbee, 415/4762557