Impact Evaluation of a Policy Intervention for HIV Prevention in Washington, DC

AIDS Behav. 2016 Jan;20(1):22-8. doi: 10.1007/s10461-015-1143-6.


Syringe exchange programs (SEPs) lower HIV risk. From 1998 to 2007, Congress prohibited Washington, DC, from using municipal revenue for SEPs. We examined the impact of policy change on IDU-associated HIV cases. We used surveillance data for new IDU-associated HIV cases between September 1996 and December 2011 to build an ARIMA model and forecasted the expected number of IDU-associated cases in the 24 months following policy change. Interrupted time series analyses (ITSA) were used to assess epidemic impact of policy change. There were 176 IDU-associated HIV cases in the 2 years post-policy change; our model predicted 296 IDU-associated HIV cases had the policy remained in place, yielding a difference of 120 averted HIV cases. ITSA identified significant immediate (B = -6.0355, p = .0005) and slope changes (B = -.1241, p = .0427) attributed to policy change. Policy change is an effective structural intervention for HIV prevention when it facilitates the implementation of services needed by vulnerable populations.

Keywords: HIV; Health policy; Injection drug users; Structural interventions; Syringe exchange programs.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Communicable Disease Control / methods*
  • Communicable Disease Control / statistics & numerical data
  • District of Columbia
  • HIV Infections / prevention & control*
  • HIV Infections / transmission
  • Health Policy*
  • Humans
  • Needle-Exchange Programs*
  • Preventive Health Services / legislation & jurisprudence
  • Substance Abuse, Intravenous*
  • Substance-Related Disorders / complications*
  • Syringes / supply & distribution