Black-White mortality from HIV in the United States before and after introduction of highly active antiretroviral therapy in 1996 (2007)

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Objectives. We sought to describe BlackWhite differences in HIV disease mortality before and after the introduction of highly active antiretroviral treatment (HAART).
Methods. BlackWhite mortality from HIV is described for the nation as a whole. We performed regression analyses to predict county-level mortality for Black men aged 2584 years and the corresponding Black:White male mortality ratios (disparities) in 140 counties with reliable Black mortality for 19992002.
Results. National BlackWhite 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.