Does Funding for HIV and Sexually Transmitted Disease Prevention Matter?

Abstract

Since the onset of the AIDS epidemic, the Centers for Disease Control and Prevention (CDC) has allocated several billion dollars for the prevention of HIV and other sexually transmitted diseases (STDs) in the United States. Using state-level data from 1981 to 1998, the authors found that greater amounts of prevention funding in a given year are associated with reductions in reported gonorrhea incidence rates in subsequent years. The authors conclude that funding for STD and HIV prevention, on the whole, appears to have a discernable impact on the incidence of STDs.

Estimated Effectiveness and Cost-Effectiveness of Federally Funded Prevention Efforts on Gonorrhea Rates in the United States, 1971???2003, Under Various Assumptions About the Impact of Prevention Funding

“…In order to estimate hypothetical gonorrhea rates in the absence of federally funded prevention efforts, this analysis used the estimated impact of federal STD and HIV prevention expenditures on gonorrhea rates in the United States obtained from a previously published study. 3 Limitations of the previous study (and other studies on which the values of the other inputs were based) therefore are limitations in the current analysis. For example, the original study of the impact of prevention funding included only CDC-allocated funds for HIV and STD prevention; non-CDC federal funds, state and local resources, and private donations were not included.…”

“…1 The estimated impact (⍀) per dollar of prevention funding on gonorrhea incidence rates was based on a recent study of the effect of HIV and STD prevention funding allocated by CDC to state and local health departments on gonorrhea incidence rates in the United States from 1981 to 1998. 3 Federal prevention expenditures were obtained from CDC records as described in more detail elsewhere. 3 Federal STD prevention expenditures were limited to general STD prevention funding awards and direct assistance from CDC to state and local health departments.…”

“…3 Federal prevention expenditures were obtained from CDC records as described in more detail elsewhere. 3 Federal STD prevention expenditures were limited to general STD prevention funding awards and direct assistance from CDC to state and local health departments. Funding allocated by the CDC or other federal agencies specifically for HIV prevention, syphilis elimination activities, infertility prevention, and other special projects were not included.…”

“…2 Compelling evidence suggests that STD prevention programs reduce STD incidence, and the decline in gonorrhea incidence since the 1970s is likely attributable in large part to STD prevention efforts. 1,[3][4][5][6][7] In fact, a recent study found that greater amounts of federal STD and human immunodeficiency virus (HIV) prevention funding in a given year were associated with decreases in gonorrhea rates in subsequent years. 3 The purpose of the current study was to apply the previously published estimates 3 of the impact of prevention funding in order to (1) estimate national gonorrhea rates that might have occurred from 1971 to 2003 had there been no federally funded STD prevention activities and (2) calculate crude estimates of the costeffectiveness of these STD prevention activities.…”

Local Public Health Systems and the Incidence of Sexually Transmitted Diseases

“…Previous studies indicate that larger local health departments, better resourced local health departments (as measured by expenditures per capita), and jurisdictions with local boards of health with policymaking authority more consistently provide a diverse set of essential public health functions, 16---19 including diagnosing and preventing health problems and informing and educating the public about health issues. Moreover, recent evidence indicates that increases in STD prevention funding are associated with reductions in gonorrhea 20 and syphilis 21 incidence rates. This suggests that resources available to local health departments and their system partners can affect the "reach" of STD prevention programs.…”