Economics of HIV Testing
Matthew Martin 4/12/2013 04:24:00 PM
- Social stigma prevents MSM from getting tested. Testing leads to treatment and safer sex practices, both of which dramatically reduce infection rates
- Unlike injection drug users who basically died out, the MSM population "demographically replenishes itself, with large numbers of individuals at risk for infection every year."
- Low awareness about the need for condom use among MSM
That said, I take issue with Pollack's last point, since data from the Behavioral Risk Factor Surveillance System, the Community Health Survey, and (if I'm not mistaken) the National Health and Nutrition Examination Survey all suggest that MSM are more likely to use condoms during penetrative sex than straight couples. The rate for straight couples is only around 35% compared to close to 50% for MSM. That's still much lower levels of condom use than we'd like to see (surely those aren't all monogamous long-term partnerships), but nevertheless, apparently MSM have a much higher transmission rate in spite of their safer sex practices.
I do, however, agree with the general point that we need to overcome the social stigma of getting tested by making HIV testing a standard recommended procedure for all adults, regardless of risk factors like sexual orientation. Pollack mentions that around 20,000 americans die each year from HIV. It is not immediately clear what fraction of those would have been preventable with early diagnosis and treatment, but modern anti-retro-viral therapies are effective enough that most HIV related deaths can be prevented with early enough treatment. Lets suppose for the moment that they are all preventable with treatment. A recent survey found that on average HIV tests costs around \$48.07 for both the test and related counseling. The Census puts the 2012 adult population at around 240 million. That means that the cost of testing everyone is about \$11.5 billion. Furthermore, the annual cost of treatment is roughly \$19,912 per patient, meaning it would have cost roughly $400 million annually to treat all 20,000 who die each year from HIV, largely due to their failure to get tested. So according to that math (which admittedly requires some dubious assumptions) the cost of annually testing everyone and treating people who would not otherwise have been diagnosed is about \$12 billion. By contrast, even the lowest possible estimate of the value saving 20,000 lives is \$60 billion (market-based estimates of the value of a life rage from \$3 million to \$7 million).
There are probably better ways to slice that data. But from my back-of-the-envelope calculation, encouraging universal annual HIV testing for all adults would generate net benefits of at least \$48 billion per year.