A Cost–Benefit Approach
Chapter 23: Threshold Analysis Practice: The Effectiveness of HIV Education
As we stressed previously, to do a CBA there must be an effect from the intervention that we are trying to evaluate. If there is no effect, one need not do an evaluation because we can avoid incurring any cost at all simply by not undertaking the intervention. However, as we also saw in Parts I and II, effectiveness cannot be taken for granted as we kept coming up with counterintuitive results. So, the first step in carrying out a CBA is to quantify effectiveness. In this chapter we use threshold analysis to illustrate one way of measuring effectiveness. This will be applied to an HIV education intervention in the United States as described by Norton et al. (1998). In principle, an HIV education program is a multi-option intervention. Once one is told all the ways that HIV can be transmitted (for example, mother-to-child transmission, unprotected sex, blood transfusions and sharing needles when taking drugs), the recipient of the information can act on it and stop all the ways that HIV is transmitted. In practice, only one or two types of behavior can be expected to be altered, leading to a reduction in one type of transmission (for example, using condoms when having sex). It all depends on the audience to whom the education program is being addressed. The education program we will be examining was geared to injecting drug users and crack cocaine users. There are two main transmission mechanisms involved with these two groups – the sharing of injecting...
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