Black-White Mortality from HIV in the United States Before and After Introduction of Highly Active Antiretroviral Therapy in 1996

Overview

Journal Am J Public Health

Specialty Public Health

Date 2007 Sep 1

PMID 17761583

Citations 54

Authors

Robert S Levine

Nathaniel C Briggs

Barbara S Kilbourne

William D King

Yvonne Fry-Johnson

Peter T Baltrus

Baqar A Husaini

George S Rust

Affiliations

Soon will be listed here.

Abstract

Objectives: We sought to describe Black-White differences in HIV disease mortality before and after the introduction of highly active antiretroviral treatment (HAART).

Methods: Black-White mortality from HIV is described for the nation as a whole. We performed regression analyses to predict county-level mortality for Black men aged 25-84 years and the corresponding Black:White male mortality ratios (disparities) in 140 counties with reliable Black mortality for 1999-2002.

Results: National Black-White disparities widened significantly after the introduction of HAART, especially among women and the elderly. In county regression analyses, contextual socioeconomic status (SES) was not a significant predictor of Black:White mortality rate ratio after we controlled for percentage of the population who were Black and percentage of the population who were Hispanic, and neither contextual SES nor race/ethnicity were significant predictors after we controlled for pre-HAART mortality. Contextual SES, race, and pre-HAART mortality were all significant and independent predictors of mortality among Black men.

Conclusions: Although nearly all segments of the Black population experienced widened post-HAART disparities, disparities were not inevitable and tended to reflect pre-HAART levels. Public health policymakers should consider the hypothesis of unequal diffusion of the HAART innovation, with place effects rendering some communities more vulnerable than others to this potential problem.

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