When more than two-thirds of the people who have been diagnosed with HIV in a country are people who inject drugs, some of the measures to prevent new infections may seem obvious, but in Malaysia, that didn’t make them easy.
Now a mathematical analysis of the benefits of the country’s harm reduction approach to preventing HIV transmission among its hardest hit population has proved the effort has saved money and protected public health.
Resistance to such steps as needle exchange programs and opioid substitution therapy included religious opposition as well as a wide-spread belief that they would encourage drug use. But with the numbers of new diagnoses in a single year climbing to nearly 7,000 by 2002, urgency prompted a practical evaluation of responses. Malaysian government officials began with a one year pilot program a few years later and it expanded fast. But now, with what a World Bank-funded report calls “multiple competing interests on public funds,” researchers did the math to prove the government was getting its money’s worth.
Using epidemiologic mathematical models of HIV transmission and disease progression with costs of associated care, they examined the present and potential future impacts of two almost entirely government funded harm reduction efforts. Needle syringe programs provided risk reduction counseling on safer injection practices and hygiene, referrals to HIV testing, and to methadone, social, health, legal, and counseling services along with sterile needles, syringes, alcohol and cotton swabs. In 2011, with an average of 429 needles and syringes supplied to each program participant, an average of 24 needles and syringes had been supplied for every person who injects drugs in Malaysia. Methadone programs took place in public health facilities, prisons, drug treatment centers and a network of private health providers, and with the exception of the latter, included HIV testing and job referrals, as well as methadone.
With all of that, some of the potential benefits reaped fell outside the scope of the report. All the same, the combined impact of the programs from 2006 to 2013 was found to be cost-effective with lasting public health and economic benefits and more than 12,000 infections averted during that time alone. By 2050, researchers calculated, the combined impact of the two programs will have prevented more than 103,000 infections.
The outcomes associated with HIV transmission, illness and costs get even more dramatic for needle syringe programs alone, They were found responsible for 12,191 of the 12,653 HIV infections averted by the combined programs. By 2050, researchers found, they will have averted 101,081 of the 103,717 HIV infections the entire approach will have kept from happening. For that reason, needle syringe programs were found cost-saving, as well as cost-effective.
While methadone maintenance therapy did not offer results as dramatic on their own, researchers note that the primary purpose of those programs is reduction of drug use. That reduction also brings reductions of attendant risks and harms beyond HIV transmission. The study did not attempt to measure the social benefits from those reductions.
The study concludes that not only are current efforts working, but that expanding the programs would provide higher returns.