Net financial benefits of averting HIV infections among people who inject drugs in Urumqi, Xinjiang, Peoples Republic of China (2005–2010)

Executive summary In September 2015, the member states of the United Nations endorsed sustainable development goals (SDG) for 2030 that aspire to human rights-centered approaches to ensuring the health and well-being of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientific evidence as they seek to better humankind. In April 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy, seen as inconsistent with human rights norms, and for which scientific evidence and public health approaches have arguably played too limited a role. The previous UN General Assembly Special Session (UNGASS) on drugs in 1998 – convened under the theme “a drug-free world, we can do it!” – endorsed drug control policies based on the goal of prohibiting all use, possession, production, and trafficking of illicit drugs. This goal is enshrined in national law in many countries. In pronouncing drugs a “grave threat to the health and well-being of all mankind,” the 1998 UNGASS echoed the foundational 1961 convention of the international drug control regime, which justified eliminating the “evil” of drugs in the name of “the health and welfare of mankind.” But neither of these international agreements refers to the ways in which pursuing drug prohibition itself might affect public health. The “war on drugs” and “zero-tolerance” policies that grew out of the prohibitionist consensus are now being challenged on multiple fronts, including their health, human rights, and development impact. The Johns Hopkins – Lancet Commission on Drug Policy and Health has sought to examine the emerging scientific evidence on public health issues arising from drug control policy and to inform and encourage a central focus on public health evidence and outcomes in drug policy debates, such as the important deliberations of the 2016 UNGASS on drugs. The Johns Hopkins-Lancet Commission is concerned that drug policies are often colored by ideas about drug use and drug dependence that are not scientifically grounded. The 1998 UNGASS declaration, for example, like the UN drug conventions and many national drug laws, does not distinguish between drug use and drug abuse. A 2015 report by the UN High Commissioner for Human Rights, by contrast, found it important to emphasize that “[d]rug use is neither a medical condition nor does it necessarily lead to drug dependence.” The idea that all drug use is dangerous and evil has led to enforcement-heavy policies and has made it difficult to see potentially dangerous drugs in the same light as potentially dangerous foods, tobacco, alcohol for which the goal of social policy is to reduce potential harms. Health impact of drug policy based on enforcement of prohibition The pursuit of drug prohibition has generated a parallel economy run by criminal networks. Both these networks, which resort to violence to protect their markets, and the police and sometimes military ...

show abstract

“…318,319 Two studies from China calculated high returns from OST based largely on the economic benefit from averting HIV transmission. 320,321 …”

Section: Treatment For Drug Dependence: the Need For Standardsmentioning

confidence: 99%

Public health and international drug policy

et al. 2016

View full text Add to dashboard Cite

show abstract

“…The results presented in this study are significantly smaller than those of studies from other countries, probably due to methodological variations such as sample size and the length of the analysis period. A study in Switzerland (Marzel et al, 2018) estimated an impact of 15,903 infections averted, with an average 454 infections per year between 1980 and 2015, whereas one in China (Ni, Fu, Chen, Hu, & Wheeler et al, 2012) estimated 5,678 infections averted with an average of 1,135 per year from 2005 to 2010.…”

Section: Discussionmentioning

confidence: 99%

Impact of funding harm reduction programs for people who inject drugs in Mexico

Valenzuela-Lara¹,

Ponce-Ramos²,

Ruiz-Herrera³

et al. 2019

Salud Ment

View full text Add to dashboard Cite

Introduction. Despite evidence from harm reduction programs, there are limited data on their impact in Mexico. The Mexican National HIV Program has supported harm reduction programs implemented by community-based organizations both financially and technically. Objective. To obtain an estimate of HIV infections averted from 2015 to 2018. Method. A deterministic model was developed to estimate the number of infections, with harm reduction projects financed by CENSIDA and implemented by Community-Based Organizations, using data reported from the period 2015 to 2018. The benefit was obtained by estimating the costs of providing prevention programs and comparing the latter to the costs of providing care. Results. An analysis of 66,973 people included in harm reduction programs showed that an estimated 869 HIV infections were averted between 2015 and 2018. Potential savings obtained by providing these harm reduction services exceeded over $600,000 Mexican pesos for every infection averted. Discussion and conclusion. Harm reduction services play a key role in reducing the incidence of HIV in Mexico. Ensuring their financing is necessary since, combined with other services, they are a cost-effective tool for reducing the economic and public health burden of HIV/AIDS.

show abstract

“…A systematic review found that all 12 included studies that examined the impact of NSPs on HIV infection found that NSPs were cost-effective according to the studies' defined willingness-to-pay thresholds (Jones, Pickering, Sumnall, McVeigh, & Bellis, 2008). Increasingly, evidence has found net financial benefits of NSPs across all regions and in high-and low-income settings (Belani Hrishikesh & Muennig, 2008;Guinness et al, 2010;Ni et al, 2012). For example, NSPs are cost saving when compared to the lifetime costs of HIV/AIDS antiretroviral treatment (Jones et al, 2008) and a recent study estimated that not only did NSPs reduce the incidence of HIV by up to 74% over a 10 year period in Australia but found that they were cost savings and had a return on investment of between $1.3 and $5.5 for every $1 invested (Kwon et al, 2012).…”

Section: Effectiveness and Cost-effectiveness Of Nspsmentioning

confidence: 99%

The cost-effectiveness of harm reduction

Wilson¹,

Donald²,

Shattock³

et al. 2015

International Journal of Drug Policy

126

View full text Add to dashboard Cite

HIV prevalence worldwide among people who inject drugs (PWID) is around 19%. Harm reduction for PWID includes needle-syringe programs (NSPs) and opioid substitution therapy (OST) but often coupled with antiretroviral therapy (ART) for people living with HIV. Numerous studies have examined the effectiveness of each harm reduction strategy. This commentary discusses the evidence of effectiveness of the packages of harm reduction services and their cost-effectiveness with respect to HIV-related outcomes as well as estimate resources required to meet global and regional coverage targets. NSPs have been shown to be safe and very effective in reducing HIV transmission in diverse settings; there are many historical and very recent examples in diverse settings where the absence of, or reduction in, NSPs have resulted in exploding HIV epidemics compared to controlled epidemics with NSP implementation. NSPs are relatively inexpensive to implement and highly cost-effective according to commonly used willingness-to-pay thresholds. There is strong evidence that substitution therapy is effective, reducing the risk of HIV acquisition by 54% on average among PWID. OST is relatively expensive to implement when only HIV outcomes are considered; other societal benefits substantially improve the cost-effectiveness ratios to be highly favourable. Many studies have shown that ART is cost-effective for keeping people alive but there is only weak supportive, but growing evidence, of the additional effectiveness and cost-effectiveness of ART as prevention among PWID. Packages of combined harm reduction approaches are highly likely to be more effective and cost-effective than partial approaches. The coverage of harm reduction programs remains extremely low across the world. The total annual costs of scaling up each of the harm reduction strategies from current coverage levels, by region, to meet WHO guideline coverage targets are high with ART greatest, followed by OST and then NSPs. But scale-up of all three approaches is essential. These interventions can be cost-effective by most thresholds in the short-term and cost-saving in the long-term.

show abstract

Net financial benefits of averting HIV infections among people who inject drugs in Urumqi, Xinjiang, Peoples Republic of China (2005–2010)

Cited by 10 publications

References 8 publications

Public health and international drug policy

Public health and international drug policy

Impact of funding harm reduction programs for people who inject drugs in Mexico

The cost-effectiveness of harm reduction

Contact Info

Product

Resources

About