Gains In HIV Treatment Remain Stratified By Race And Class

A new study published in the Archives of Internal Medicine journal yesterday finds significant variation in HIV death rates across racial and sociological lines. Although the death rate for Americans with higher levels of education has significantly declined since 1993, the death rate for those with less education — which the researchers used to extrapolate economic status — barely budged. Deaths among low-income black women did not decline at all during the same time period.

The study looked at the education levels of more than 90,000 adults between the ages of 25 to 64 who died from HIV infections between 1993 and 2007. Researchers were interested in determining whether new treatments for HIV, particularly the highly active antiretroviral therapies (HAART) medications that first became available in 1996, have helped reduce HIV death rates since their development. Although they found that overall death rates did drop across races after 1996 — African-Americans, who had the highest infection rates, saw the biggest drops — significant discrepancies emerged along socioeconomic lines:

Among black men with a college degree, HIV deaths for every 100,000 people in the population plummeted from 117 before HAART to 15 after those medications became available. For similarly educated white men, those numbers slid from 26 to two.

But when researchers looked just at men and women with less education — those who had gone no farther than high school — the numbers were alarming. Black women with no more than a high school diploma saw almost no change in death rates from HIV over 15 years of the study. From 1993 to 1995, about 30 black women for every 100,000 people in the general population died of AIDS. From 2005 to 2007, that number was about 27.

“This is very, very striking and probably one of the bellwether findings of the study,” says [Dr. Edgar P. Simard, a senior epidemiologist with the American Cancer Society].

The researchers pointed out that although HIV treatment is advancing, it isn’t reaching all racial or socioeconomic groups equally, and comparing death rates before and after the widespread availability of HAART drugs pinpoints those disparities. For example, the study found that less-educated black men died from HIV at a higher rate in the years after 1996 — once HAART drugs had been made available — than less-educated white men did in the early 1990s, even before advanced treatment had been developed.

Rates of HIV infection in cities across the country are disproportionately higher among low-income communities, which often lack public health resources. In the nation’s capital city, the infection rate for heterosexual African-American women in the city’s poorest neighborhoods nearly doubled over the past two years.