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Health Disparities Research
UNITED STATES:
"Black-White Mortality from HIV in the United States
Before and After Introduction of Highly Active Antiretroviral Therapy in 1996"
American Journal of Public Health Vol. 97; No. 10: P. 1884-1892,
(10..2007) Robert S. Levine, MD; Nathanial C. Briggs, MD, MSc; Barbara S.
Kilbourne, PhD; William D. King, MD, JD; Yvonne Fry-Johnson, MD; Peter T.
Baltrus, PhD; Baqar A. Husaini, PhD; George S. Rust, MD, MPH
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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