The published literature on costs

Costs
The published literature on costs and cost-effectiveness of school-based sex education and HIV prevention is
sparse, including two US-based studies, one from Tanzania and the Prevent AIDS Network for Cost-Effectiveness
Analysis study (PANCEA), a multi-country intervention in Mexico, Uganda, South Africa, India and Russia.
The cost-effectiveness of a programme will depend to a considerable extent on the HIV rate among the targeted
population. For example, the Safer Choices programme (see below) was implemented in states where HIV rates
among young people were very low. Thus, it prevented less than one case of HIV. However, if the same programme
were implemented in sub-Saharan Africa, it would prevent many cases of HIV and be dramatically more
cost-effective. Thus, cost-effectiveness depends not only on costs and on ability to change behaviour, but also on
incidence among the target group.
Published work from the US includes a study of the US-based Safer Choices programme, a school-based HIV,
STD and unintended pregnancy prevention intervention for high school students. This study55 included estimation
of intervention costs, calculation of cases of HIV, STDs and pregnancies averted, which were then translated into
medical and social costs averted. The net benefi t of the programme was then calculated. The authors concluded
that, at an intervention cost of $105,243, the programme achieved a 15% increase in condom use and an 11%
increase in contraceptive use within one year among 354 sexually active students. It is estimated that 0.12 cases of
HIV, 24.37 cases of Chlamydia, 2.77 cases of gonorrhoea, 5.86 cases of pelvic infl ammatory disease and 18.5 pregnancies
were averted. The authors calculate that, for every dollar invested, $2.65 were saved in terms of medical
and social costs and conclude that the Safer Choices programme is both cost-effective and cost-saving.