The authors sought to describe black/white differences in HIV disease mortality before and after the introduction of highly active antiretroviral treatment (HAART). Using data from the nation as a whole, the researchers performed regression analysis to predict county-level mortality for black men ages 25-84 and the corresponding black:white mortality ratios (disparities) in 140 counties with reliable black mortality for 1999-2002.

The study found that 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 ratio after controlling for percentage of the population who were black and percentage of the population who were Hispanic. Neither contextual SES nor race/ethnicity was a significant predictor after controlling for pre-HAART mortality. Contextual SES, race, and pre-HAART mortality were all significant and independent predictors of mortality among black men.

"Although nearly all segments of the black population experienced widened post-HAART disparities, disparities were not inevitable and tended to reflect pre-HAART levels," the authors concluded. "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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