Unformatted text preview: and $28.93 per client, respectively. The
biggest discrepancy between these studies and the MDICP costs are the costs of bringing the testing into local villages.
The initial budget for the government of Lesotho to test each citizen going door-to-door was approximately $10.00 per
person, which would reach a total cost of approximately $10 million. Actual costs of this program (begun in late 2005)
are not yet available (Integrated Regional Information Networks 2004). 1858 THE AMERIcAN EcONOMIc REVIEW DEcEMBER 2008 of heavily subsidized condom purchases (such as the door-to-door “sales”23) or on acceptance of
freely distributed condoms.
Given the high ratio of costs to HIV-positive diagnosis in door-to-door testing in this setting, and the lack of significant effects of diagnosis on some condom purchase behavior and
sexual activity, other interventions might be much more cost-effective for HIV prevention. For
example, an evaluation of a randomized trial in Mwanza, Tanzania, estimated that treating nonHIV STIs had an incremental costs of $217.62 per HIV infection averted (Lucy Gilson et al.
1997) and another simulation of a similar intervention estimated a cost of $78.24 per infection
averted (Oster 2005). Other less direct interventions may also be effective prevention strategies—for example, improving blood supply safety (estimated cost of $172 per infection averted;
Rex Winsbury 1995), preventing mother-to-child transmission ($298–$506 per infection averted;
Elliot Marseille et al. 1999), or performing circumcisions (Bertran Auvert et al. 2005; Ronald H.
Gray et al. 2007).24
In sum, the significant effects claimed for broad-based HIV testing and counseling efforts,
deemed the “single most influential driver for behavior change” (Global Business Coalition
2004), are not detected within these data. Neither the knowledge of HIV status nor the personal
attention and education from the nurses to practice safe sex during the VCT counseling sessions
appears to have had a significant impact on purchasing condoms or on the likelihood of having
sex after two months.
V. Conclusion This study is the first to analyze the impact on obtaining...
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