Successful HIV Prevention Requires Significant Shifts in Public Policy

New article published in Health Affairs journal urges lawmakers to implement programs proven to fight AIDS and other diseases

Providing clean syringes to injecting drug users and stable housing to the homeless are among the most cost-effective strategies for improving global health and stopping the spread of AIDS, according to a new article by Judith Auerbach, Ph.D., vice president for science and public policy at the San Francisco AIDS Foundation.

In the article, published today in the November/December 2009 issue of Health Affairs, Auerbach urges lawmakers in the United States and around the world to enact policies that will help people protect themselves against HIV infection and other diseases.

Auerbach’s analysis comes as Congress is considering legislation that would lift a 21-year ban on federal funding for syringe exchange, which studies have shown reduce HIV transmission by discouraging the sharing of dirty needles without increasing drug use. She notes that of the 16 million injecting drug users worldwide, about 3 million are infected with HIV.

The global financial crisis requires us to implement the most cost-effective and sustainable strategies to fight AIDS, according to Auerbach. “In HIV prevention, this requires broadening our focus from attempting to change the behavior of individuals to enacting legal and policy changes to create an enabling environment for societal-level health promotion and disease prevention that will have beneficial effects beyond HIV/AIDS,” she writes.

With homeless people 16 times more likely to be diagnosed with HIV and up to seven times more likely to die of HIV-related causes than the general population, Auerbach says subsidized housing should be a part of care and support services for the most vulnerable. Stable housing enables HIV-infected people to better adhere to their medications, according to the article, and emerging evidence suggests that it helps to reduce HIV-related risk behavior.

Other policy changes recommended by Auerbach to promote HIV prevention and global health include wider availability of drug substitution therapy for heroin addicts and economic programs that empower poor women and girls.

“If we fail to adopt these strategies, we can expect to incur incalculable costs in dollars, lives, and social equality for decades to come,” concludes Auerbach.

The San Francisco AIDS Foundation provides leadership to prevent new HIV infections. Linking community experience with science, the Foundation develops groundbreaking prevention programs and bold policy initiatives to promote health and create sustainable progress against HIV. Established in 1982, the Foundation refuses to accept that HIV transmission is inevitable.

Health Affairs is the leading journal of health policy thought and research. The peer-reviewed journal was founded in 1981 under the aegis of Project HOPE, a nonprofit international health education organization. Health Affairs explores health policy issues of current concern in both domestic and international spheres.

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