Rethink HIV: Preventing Sexual Transmission Assessment, Behrman Kohler

Assessment Paper

The purpose of the RethinkHIV project is to identify and highlight the most cost-effective responses to HIV/AIDS in Sub-Saharan Africa (SSA) with economic analyses of the benefits and costs of specific interventions in six categories of responses to HIV/AIDS. This is the Assessment Paper on the first of the six topics: Prevention of Sexual Transmission of HIV.  

As is well-known, sexual infections are a major source of the spread of HIV/AIDS generally (UNAIDS 2010), and are thought to be by far the most important source of the spread of HIV/ AIDS in SSA, though there also are other sources of spread of the disease such as maternal-child infection and the use of contaminated blood or needles. Sexual interactions may directly result in the transmission of HIV but they also may increase the vulnerability to the HIV virus through transmitting other sexually transmitted diseases. Interventions to reduce sexual infections broadly speaking can work through reducing the frequency of such interactions or through reducing the risks of sexual infection per sexual encounter. Selection of partners, including with respect to age and risk behaviors of the partner, condom use or other risk reduction strategies with a specific partner, and biomedical interventions that affect HIV transmission can all affect HIV infection risks. Interventions have been proposed to work through both of these channels, though with greater emphasis probably on the latter.

In this Assessment Paper, we first discuss how we identified solutions through preventing sexual infections suggested by the literature. We then discuss benefit-cost analyses to help provide a framework for understanding what information is necessary for evaluating possible interventions. We then turn to assumptions for our estimated benefit-cost ratios for those solutions through preventing sexual infections suggested by the literature and then present the estimated benefit-cost ratios and cost-effectiveness estimates for averting infections and per DALY. 

The Assessment Paper outlines the costs and benefits of at least three of the most promising responses, interventions, or investments to HIV/AIDS in Sub-Saharan Africa within the respective category. The Assessment Paper on the topic of Prevention of Sexual Infection is authored by Jere Behrman, the W.R. Kenan, Jr. Professor of Economics and Director of Population Studies Center at the University of Pennsylvania, and Hans-Peter Kohler, the Frederick J. Warren Professor of Demography, University of Pennsylvania.

The working paper used by the Expert Panel is available for download here, the finalized paper has been published in the Rethink HIV book by Cambridge University Press.