Black-White mortality from HIV in the United States before and after introduction of highly active antiretroviral therapy in 1996.
OBJECTIVE
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.
Levine
Robert S
RS
Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37205, USA. rlevine@msm.edu
Briggs
Nathaniel C
NC
Kilbourne
Barbara S
BS
King
William D
WD
Fry-Johnson
Yvonne
Y
Baltrus
Peter T
PT
Husaini
Baqar A
BA
Rust
George S
GS
D000328:Adult; D017677:Age Distribution; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D044383:Black People; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D011634:Public Health / Q000639:trends; D012044:Regression Analysis; D017678:Sex Distribution; D012923:Social Class; D013997:Time Factors; D014481:United States; D044465:White People; D001741:Black or African American