New drug treatments have dramatically improved survival for people infected with HIV, but a new study finds that African Americans and less educated Americans have not seen the same gains as others, suggesting differences in access to available treatments.
"There have been substantial declines in HIV death rates, but not everyone has benefited equally from the drugs that have been available since 1996," said Edgar Simard, the study's lead author and a senior epidemiologist at the American Cancer Society in Atlanta.
The drugs currently used against HIV are collectively known as highly active antiretroviral therapy, or HAART. They help suppress the virus in a person's blood, which helps the immune system stay strong and may delay the onset of AIDS.
But, the authors note in the Archives of Internal Medicine, while HIV fell to 24th leading cause of death for whites, it rose to be the ninth leading cause of death for blacks.
Using data from 26 states, the researchers analyzed rates of deaths attributed to HIV of 91,307 white, black and Hispanic men and women between the ages of 25 and 64 years old.
They also wanted to see how sex, race and socioeconomic status influenced death rates and used education level as a rough proxy for poverty.
Looking at two time periods, 1993 to 1995 and 2005 to 2007 - before and after HAART became available - they found that overall HIV death rates fell for most groups.
The most pronounced declines were in groups that started out with higher death rates in the 1990s.
For example, the most educated black men, with 16 or more years of schooling, saw the greatest decline, from about 118 deaths per 100,000 men in the mid-1990s to about 15 deaths per 100,000 in the mid-2000s.
For the most educated white men, the decline was smaller, but their death rate was lower to start with. It fell from about 26 deaths per 100,000 to about 2 deaths per 100,000.
More sobering statistics, however, were found for the least educated black men and women - those who completed 12 or fewer years of schooling.
Between the two time periods, HIV death rates among the least educated black women remained essentially the same at around 27 to 29 deaths per 100,000 women.
For the least educated black men, rates fell from about 122 deaths per 100,000 to about 53 deaths per 100,000.
Though death rates for the poorest black men fell by more than half, the authors point out, they are still higher than the rates the poorest white men started out with in the 1990s.
A long way to go
Overall, the disparities between the most and least educated people have gotten worse, the researchers write.
The report highlights black men and minority women, especially those who are poor, as the people who are most vulnerable to death from HIV.
That, the researchers say, may be because they don't know they have HIV, don't know about HIV prevention or they don't have access to the healthcare system.
"(The findings) suggest that it's really those that have the least amount of access who are really worst off, and our efforts need to target those people," said Jennifer Kates, vice president and director of global health and HIV policy at the Kaiser Family Foundation in Washington, DC.
Dr. William Cunningham, who wrote an editorial accompanying the study, said there needs to be research dedicated to targeting vulnerable populations to figure out how to get them into treatment and encourage them to stay with it.
"We need the knowledge. We need to know what to do. It's the same approach we use for everything else... We know it works, so we follow it. If we don't know how to change it, then we're just grasping in the dark," Cunningham told Reuters Health.
Kates, who was not involved with the new research, said the tools are available to achieve an AIDS-free generation, but warned there is still a long way to go.