Expanded Public Health Programs Could Reduce Spread of HIV

Can spending on public health programs reduce the spread of AIDS?

Not spending much appears to be related to higher rates of new infections and deaths, a Yale Global Health Leadership Institute (GHLI) study of states' spending patterns finds. Rates of new HIV infections and AIDS deaths might be reduced by improving state spending on public health and social service programs, according to the study.

“HIV and AIDS still affect a significant percentage of our population. We need to do something to reach those people who are not being treated and to generally prevent new infections. Perhaps analyzing where money is being spent is the start for new ways to address HIV,” said Kristina Talbert-Slagel PhD, senior author and senior scientific officer at GHLI.

The study noted that the annual rate of 50,000 new HIV infections has not dropped in over a decade and that the AIDS epidemic persists despite 30 years of advances in prevention and treatment.

“Of the 1.2 million people in the United States who are living with HIV, only an estimated 25% achieve viral suppression through antiretroviral therapy, with the remainder either unaware that they are infected (20%) or not fully engaged in medical care (>50%),” the study added.

The retrospective, longitudinal study defined the association between state spending and HIV/AIDS by looking at the rates of HIV and AIDS diagnoses and AIDS deaths per 100,000 people. This association “was observed not only for social service and public health spending from the previous year, but also when we incorporated spending from 5 years earlier and persisted even after adjusting for healthcare spending and socio-economic factors across the states.”

Maps used to illustrate the findings show, for example, that Texas falls both in the highest quintile for HIV and AIDS cases per 100,000 population and the lowest quintile for social service and public health spending per person in poverty. Meanwhile, Colorado is in the lowest group for HIV cases per 100,000 and the highest rates for social service and public health spending.

In analyzing the data from the 50 continental states from 2000 to 2009, the researchers reported that spending on education per capita was most significantly associated with lower HIV/AIDS case rates and AIDs deaths. Public health spending also was significantly associated with lower AIDS case rates and deaths.

Although earlier studies have looked at the impact of transportation services, income assistance and other factors on people living with AIDS, the study said it is the first to examine the relationship between state investment in social services and public health and clinical health outcomes for people at risk for HIV infection and those living with HIV/AIDS.

“Our findings suggest that spending on social services and public health may provide a leverage point for state policymakers to reduce HIV/AIDS case rates and AIDS deaths in their state,” the authors concluded.

The study was published in the Feb. 20 issue of the journal, AIDS.