Should Cities Fund Needle Exchange Programs?

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It is possible to regard such statistics as a matter of just deserts, or at least as a regrettable effect of an avoidable cause. People should know that if they use dangerous drugs in the company of dangerous people, bad things are likely to happen. And their sexual partners, though perhaps not drug users themselves, should confine themselves to more wholesome companions. It is troubling, of course, to learn that more than half of children born with AIDS in the U.S. are the offspring of IDUs or their sexual partners, but hardly news that the sins of fathers and mothers are frequently visited upon their progeny.

Even those who subscribe to such views, however, should pause in the face of the enormous economic costs of treating people infected with HIV or already suffering from AIDS. A 2005 CDC report estimated that the current lifetime treatment cost of a person with HIV is $210,000. At current rates, approximately 40,000 people are infected with HIV each year. Treating just those who have been infected in the last five years for the rest of their lives will cost an estimated $42 billion. Other estimates are even higher. A major study published in the November 2006 issue of Medical Care estimates that the current cost of lifetime treatment for a person with HIV with newer antiretroviral drugs is $618,900, though that number has been projected to drop to $385,200. The same report estimates that the net savings for each case prevented is $303,100.

Many people infected with these diseases receive little or no medical treatment, but of those who do, Medicaid or other public funds bear a high proportion of the cost. For example, from 2001-2005, Texas State Medicaid costs for HIV/AIDS services totaled $316.5 million—and that did not include outlays by private payers, insurance companies, or government programs such as Medicare and Veterans Affairs. Treatment for hepatitis C can run to $20,000 to $30,000 per year, with lifetime costs of more than $300,000 and a population six times larger than people living with HIV and AIDS. Of those whose hepatitis C progresses to end-stage liver disease later in life, Medicare picks up the $300,000 or so for the one in four fortunate enough to receive a transplant.

Preventing just one case of either disease would save far more than the annual cost of a first-rate needle-exchange program. The CDC report estimates that preventing just 3430 cases of HIV infection—less than ten percent—would produce a net cost savings to society.

Fortunately, the means to dramatic reduction of such costs are well known and thoroughly proven.