title: Structural interventions to prevent HIV/sexually transmitted disease: are they cost-effective for women in the southern United States?
abstract: BACKGROUND
  Structural interventions are theoretically promising for populations with a low prevalence of HIV, because they can reach large numbers of people to influence their social norms and collective risky behaviors for a relatively low cost per person. Because HIV transmission is continuing to increase among women in the southern United States, interventions to stem this epidemic are particularly warranted. This study explores whether structural interventions may be a cost-effective way to prevent HIV in this population.
  
  
  METHODS
  We used the cost-effectiveness estimator, "Maximizing the Benefit" to determine the relative cost-effectiveness of 6 structural HIV prevention interventions. "Maximizing the Benefit" is a spreadsheet tool using mathematical models to estimate the cost per HIV infection prevented taking into account the epidemiologic contexts, behavioral change as a result of an intervention, and the costs of intervention. We applied estimates of HIV prevalence related to blacks in the southern United States.
  
  
  RESULTS
  All the structural interventions were cost-effective compared with average lifetime treatment costs of HIV, but mass media, condom availability, and alcohol taxes theoretically prevented the largest numbers of HIV infections.
  
  
  CONCLUSIONS
  Although the assumptions used in cost-effectiveness estimates have many limitations, they do allow for a relative comparison of different interventions and help to inform policy decisions related to the allocation of HIV prevention resources. Structural interventions hold the greatest promise in reducing HIV transmission among low-prevalence populations.
authors.affiliation: RAND Corporation, Santa Monica, California 90405, USA. dcohen@rand.org
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Cohen
authors.forename: Shin-Yi
authors.initials: SY
authors.lastname: Wu
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Farley
mesh_terms: D017280:Condoms; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006266:Health Education / Q000191:economics*; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D008402:Mass Media; D018671:Needle-Exchange Programs; D015995:Prevalence; D011640:Public Policy; D012309:Risk-Taking; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015144:Southeastern United States / Q000453:epidemiology; D013660:Taxes; D016387:Women's Health