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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2005.081489v1 AJPH.2005.081489v2 97/10/1884    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Levine, R. S. Articles by Rust, G. S. Search for Related Content PubMed PubMed Citation Articles by Levine, R. S. Articles by Rust, G. S. Related Collections Community Health Other Health Service Delivery HIV/AIDS Public Health Practice African Americans/Blacks Socioeconomic Factors

Robert S. Levine, MD, Nathaniel 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 and George S. Rust, MD, MPH

Robert S. Levine and Nathaniel C. Briggs are with the Department of Family and Community Medicine, Meharry Medical College, Nashville, Tenn. Barbara S. Kilbourne is with the Department of Sociology, Tennessee State University, Nashville. William D. King is with the Department of Internal Medicine, University of California, Los Angeles. Yvonne Fry-Johnson, Peter T. Baltrus, and George S. Rust are with the National Center for Primary Care, Morehouse School of Medicine, Atlanta, Ga. Baqar A. Husaini is with the Center for Health Research, Tennessee State University, Nashville.

Correspondence: Requests for reprints should be sent to Robert S. Levine, MD, Department of Family and Community Medicine, Meharry Medical College, 1005 D.B. Todd Jr Blvd, Nashville, TN 37205 (e-mail: rlevine{at}msm.edu).

Objectives. We sought to describe Black–White differences in HIV disease mortality before and after the introduction of highly active antiretroviral treatment (HAART).

Methods. Black–White mortality from HIV is described for the nation as a whole. We performed regression analyses to predict county-level mortality for Black men aged 25–84 years and the corresponding Black:White male mortality ratios (disparities) in 140 counties with reliable Black mortality for 1999–2002.

Results. 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 rate ratio after we controlled for percentage of the population who were Black and percentage of the population who were Hispanic, and neither contextual SES nor race/ethnicity were significant predictors after we controlled for pre-HAART mortality. Contextual SES, race, and pre-HAART mortality were all significant and independent predictors of mortality among Black men.

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