Race, education linked to differences in HIV mortality rates

While widespread use of multi-drug treatment regimens have sharply reduced HIV-related deaths, mortality rates remain disproportionately high for African Americans, especially those with limited education, according to a new study.

In what is believed to be the first analysis of its kind, researchers assessed HIV mortality rates among different racial and ethnic groups and accounted for gender and level of education.

Among other findings, authors wrote that HIV death rates were significantly elevated among blacks, relative to whites, within every education category.

“HIV has risen in prominence as a cause of death for blacks while simultaneously falling in prominence for whites,” wrote lead author Edgar Simard, senior epidemiologist for the American Cancer Society. “It was the ninth leading cause of death among blacks vs. the 24th leading cause of death among whites in 2007.”

The analysis, which was published Monday in Archives of Internal Medicine, reviewed records for more than 91,000 HIV-related deaths among adults between 1993 and 2007.

The use of so-called highly active anti-retroviral therapy, or HAART, for the treatment of human immunodeficiency virus infection began in 1996. Since that time, HIV mortality rates have dropped significantly for all groups except black women with 12 or fewer years of education, authors wrote.

Among men with the most education, mortality rates per 100,000 population decreased from 118 to 15 for blacks and from 26 to 2 for whites. The mortality rate for black women with low education remained steady at 27 per 100,000.

Study authors suggested that black men as well as low-income black and Latino women faced greater risks due to lack of knowledge about HIV prevention, their own testing status, a lack of access to healthcare, social stigma and marginalization.

“These findings suggest the need for focused interventions and resources to facilitate the identification of high-risk individuals, as well as entry and retention into care for these most vulnerable groups affected by the HIV epidemic in the United States,” they wrote.

In a separate commentary piece published with the study, Dr. William Cunningham of the UCLA School of Medicine wrote that more must be done to eliminate disparities in HIV mortality.

“We need a variety of different studies, including observational studies, as well as interventions to find the most effective and cost-effective interventions that can reverse this trend,” Cunningham wrote.

The study included data from states that fully reported education level to the National Vital Statistics System. California was not included in the sample.