Deborah A. Cohen

Cost as a barrier to condom use: the evidence for condom subsidies in the United States.

OBJECTIVES This study sought to determine the impact of price on condom use. METHODS A program based on distribution of condoms at no charge was replaced with one providing low-cost condoms (25 cents). Pretest and posttest surveys asked about condom use among persons reporting 2 or more sex partners. RESULTS At pretest, 57% of respondents had obtained free condoms, and 77% had used a condom during their most recent sexual encounter. When the price was raised to 25 cents, the respective percentages decreased to 30% and 64%. CONCLUSIONS Cost is a barrier to condom use. Free condoms should be distributed to encourage their use by persons at risk for HIV and other sexually transmitted diseases.

Condom distribution: a cost-utility analysis.

Objective: To explore the cost-effectiveness of a condom distribution programme. Methods: We conducted a cost-utility analysis of a social marketing campaign in which over 33 million condoms were made freely available throughout Louisiana. Surveys among 275,000 African Americans showed that condom use increased by 30%. Based on the estimated cost of the intervention and costs of HIV/AIDS-associated medical treatment, we estimated the quality-adjusted life years (QALYs) saved, and number of HIV infections averted by the programme. Results: The programme was estimated to prevent 170 HIV infections and save 1909 QALYs. Over

An Economic Evaluation of a School-Based Sexually Transmitted Disease Screening Program

33 million in medical care costs were estimated to be averted, resulting in cost savings. Sensitivity analyses showed that these results were quite stable over a range of estimates for the main parameters. Condom increases as small as 2.7% were still cost-saving. Conclusion: Condom distribution is a community-level HIV prevention intervention that has the potential to reach large segments of the general population, thereby averting significant numbers of HIV infections and associated medical costs. The intervention is easy to scale up to large populations or down to small populations. The financial and health benefits of condom social marketing support making it a routine component of HIV prevention services nationally.

Screening for sexually transmitted diseases during preparticipation sports examination of high school adolescents

Background A school-based sexually transmitted disease (STD) screening program was implemented in eight New Orleans public high schools to detect chlamydia and gonorrhea. Goal The goal was to assess the incremental cost-effectiveness of replacing non-school-based screening with the school-based screening program. Study Design A decision-analysis model was constructed to compare costs and cases of expected pelvic inflammatory disease (PID) in the school-based screening scenario versus a non-school-based screening scenario. Cost-effectiveness was quantified and measured as cost per case of PID prevented. Results Under base-case assumptions, at an intervention cost of

Condoms for men, not women results of brief promotion programs

86,449, the school screening program prevented an estimated 38 cases of PID, as well as

Group counseling at STD clinics to promote use of condoms.

119,866 in treatment costs for PID and its sequelae, resulting in savings of

Prescription for a Healthy Nation: A New Approach to Improving Our Lives by Fixing Our Everyday World

1524 per case of PID prevented. Results remained cost-saving over a reasonable range of model parameter estimates. Conclusions The New Orleans school-based chlamydia screening program was cost-effective and cost-saving and could be cost-effective in other settings. School-based screening programs of this type are likely to be a cost-effective use of public funds and can reduce the burden of STDs among adolescents.

Why Is Poverty Unhealthy

In an urban school district, 636 students in grades 9-12 were tested for Chlamydia trachomatis and Neisseria gonorrhoeae by ligase chain reaction assays using specimens collected for routine urinalyses during sports physical examinations. Chlamydia and gonorrhea prevalences were 2.8% and 0.7% among males, and 6.5% and 2.0% among females, respectively. Among athletes infected with either sexually transmitted disease (STD), 93.1% reported no symptoms, and treatment was documented for 75.9%. Sports physicals offered a unique opportunity to screen and treat adolescents for STDs and to provide STD-prevention counseling.