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Public policy
Containment of HIV
Fred Wenstøp
Norwegian School of Management, BI
17/07/2015
Fred Wenstøp
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The Decision panel
• The Panel
– Governmental advisor on AIDS matters
• Svein-Erik Ekeid
– Deputy minister, Ministry of Social Affairs
• Emil Hansen
– Director of National Institute of Public Health
• Bodolf Hareide
• Decision context
– Identification of viable program target groups
• Value focusing
– Essential values were identified without discussing
consequences of alternatives
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Value structure
Minimize social economic costs of the HIV epidemic
Minimize consequences
for the individual and
the society
Minimize future
cases of HIV
Minimize economic
costs of program
and morbidity
Right to privacy
Health care of AIDS patients
Anxiety in the society
Costs of program
Anxiety in exposed persons
Loss of income
Life quality of HIV+'s
Personal stigma
Group stigma
Early treatment
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Framing the problem
Decision Criterion
Cases prevented
Rights invasion
Anxiety creation
Anxiety reduction
Life quality reduction
Personal stigma
Group stigma
Economic costs
Early treatment
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Unit
Worst value Best value
persons
0
4800
1000 persons
12000
0
1000 persons
12000
0
1000 persons
0
1200
person-years
7200
0
persons
120
0
1000 persons
80
0
mill. NOK
5000
-9000
persons
0
2400
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Weights
Costs Early
• Weight elicitation
–
–
–
–
Computer interactive
Discussions
Emotional responses
Unanimous result
G.stigma
P.stigma
Quality
Anx. red
Cases
Anx. cre
Rights
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Viability study
Target group according to HIV prevalence in home country
Decision Criterion
No action Low Medium High
Cases prevented
0
665
510
100
Rights invasion
0
67
38
4
Anxiety creation
0
67
38
4
Anxiety reduction
0
7
4
0
Life quality reduction
0
141
5700 2370
Personal stigma
0
2
95
40
Group stigma
0
67
38
4
Economic costs
0 -1332
-1027 -203
Early treatment
0
47
1900
790
Utility
0.285 0.285
0.285 0.285
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
Infections N 1  (1  prev trans)5intercourses

Infection potential
N
Europeans
American &
Oriental
Sub-Sahara
Size of sexual
contact group
15500
3700
480
Annual no. of
intercourses
25
34
30
HIV transmission prob.
0.001
0.01
0.05
HIV prevalence
0.01
0.05
0.2
Expected no. of
infections, 5 yrs
20
266
376
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HIV Case: Conclusion
• The viability study showed that
– in order to be efficient, any program directed against an
immigrant group must prevent new HIV cases at least:
• Europeans
665
• Americans & orientals 510
• Sub-Sahara Africans
100
• A projection study showed that
– if left to themselves they would at the maximum infect
• Europeans
20
• Americans & orientals 266
• Sub-Sahara Africans
376
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