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Edward H. Kaplan, PhD and Michael H. Merson, MD

The authors are with the Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn. Edward H. Kaplan is also with the Yale University School of Management, New Haven, Conn. Both were members of the Institute of Medicine’s Committee on HIV Prevention Strategies in the United States.

Correspondence: Requests for reprints should be sent to Edward H. Kaplan, PhD, Yale University School of Management, PO Box 208200, New Haven, CT 06520–8200 (e-mail: edward.kaplan{at}yale.edu).

The primary goal of HIV prevention is to prevent as many infections as possible. This requires allocating HIV-prevention resources according to costeffectiveness principles: those activities that prevent more infections per dollar are favored over those that prevent fewer. This is not current practice in the United States, where prevention resources from the federal government to the states flow in proportion to reported AIDS cases.

Although such allocations might be considered equitable, more infections could be prevented for the same expenditures were cost-effectiveness principles invoked. The downside of pure cost-effective allocations is that they violate common norms of equity. In this article, we argue for a middle ground that promotes both equity and efficiency in allocating federal HIV-prevention resources.

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