Journal Article

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

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

2007

Overview

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.

• Publisher: Am Public Health Assoc,American Public Health Association
• Subject: Adoption of innovations / Adult / African Americans / Age Distribution / Age groups / Aged / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Antiretroviral Therapy, Highly Active / Biological and medical sciences / Black or African American / Black People / Black white differences / Confidence intervals / Confidentiality / Context / Counties / Data collection / Diffusion / Drug overdose / Drug therapy / Drug use / Educational attainment / Elderly women / Epidemiology / Ethnicity / Female / General aspects / Health disparities / High school graduates / Hispanic people / HIV / HIV Infections - drug therapy / HIV Infections - mortality / Human immunodeficiency virus / Human viral diseases / Humans / Infectious diseases / Innovations / Male / Medical sciences / Medical treatment / Men / Middle Aged / Miscellaneous / Mortality / Mortality rates / Multivariate analysis / Older people / Per capita / Policy making / Population / Population Surveillance - methods / Prescription drugs / Protease inhibitors / Public health / Public Health - trends / Public health. Hygiene / Public health. Hygiene-occupational medicine / Race / Racial differences / Regression Analysis / Research and Practice / Sex Distribution / Social Class / Socioeconomic factors / Socioeconomic status / Socioeconomics / Software / Statistical analysis / Studies / Time Factors / United States / Viral diseases / Viral diseases of the lymphoid tissue and the blood. Aids / White People / Womens health