Examination of Inequalities in HIV/AIDS Mortality in the United States From a Fundamental Cause Perspective

In the current study, the researchers assessed changes in socioeconomic status (SES) and black and white inequalities in HIV/AIDS mortality prior to and after the introduction of highly active antiretroviral therapy (HAART). Taking a fundamental cause perspective, they used negative binomial regression to analyze trends in county-level gender-, race-, and age-specific HIV/AIDS mortality rates of persons ages 15 to 64. The study period was 1987 to 2005.

"Although HIV/AIDS mortality rates decreased once HAART became available, the declines were not uniformly distributed among population groups," the authors wrote. Associations between SES and HIV/AIDS mortality, as well as between race and HIV/AIDS mortality, were present in the pre-HAART period. In the peri- and post-HAART periods, however, these associations were significantly greater. During the post-HAART period, higher SES and white race were associated with the greatest declines in mortality.

"Our findings support the fundamental cause hypothesis, as the introduction of a life-extending treatment exacerbated inequalities in HIV/AIDS mortality by SES and by race," the authors concluded. "In addition to a strong focus on factors that improve overall population health, more effective public health interventions and policies would facilitate an equitable distribution of health-enhancing innovations."

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