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. 2007 Oct;97(10):1884-92.
doi: 10.2105/AJPH.2005.081489. Epub 2007 Aug 29.

Black-White mortality from HIV in the United States before and after introduction of highly active antiretroviral therapy in 1996

Robert S Levine  1 , Nathaniel C Briggs, Barbara S Kilbourne, William D King, Yvonne Fry-Johnson, Peter T Baltrus, Baqar A Husaini, George S Rust
Affiliations

Black-White mortality from HIV in the United States before and after introduction of highly active antiretroviral therapy in 1996

Robert S Levine et al. Am J Public Health. 2007 Oct.

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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Figures

FIGURE 1—
FIGURE 1—
Black-to-White HIV-related mortality rate ratios among (a) men aged 25 to 74 years and (b) women aged 25 to 64 years: United States, 1990 to 2002. Note. Reporting is restricted to 10-year age groups for which reliable data for all years were available. The horizontal line indicates the introduction of highly active antiretroviral therapy.
FIGURE 2—
FIGURE 2—
Black:White HIV mortality among men aged 25 years and older in the United States and in US counties with a mortality rate ratio (MRR) of 2.0 or less, by (a) MRRs and (b) race-specific, age-adjusted mortality rates: 1990–2002. Note. In counties with at least 20 deaths among Blacks from HIV/AIDS.
FIGURE 3—
FIGURE 3—
Black:White HIV mortality among men aged 25 years and older in the United States and in US counties with a mortality rate ratio (MRR) of 15.0 or higher, by (a) MRRs and (b) race-specific, age-adjusted mortality rates: 1990–2002. Note. In counties with at least 20 deaths among Blacks from HIV/AIDS.
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References

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