AIDS mortality, "race or color", and social inequality in a context of universal access to highly active antiretroviral therapy (HAART) in Brazil, 1999-2004

Highly active antiretroviral therapy (HAART) has led to a substantial increase in the survival of people living with AIDS, despite heterogeneities among individuals from different socioeconomic strata. The present paper analyzes AIDS deaths in Brazil during a period in which HAART became a key treatment regimen, exploring the hypothesis that "race or color" defines one dimension of socioeconomic inequality in Brazil. AIDS mortality, stratified by gender and "race or color", was calculated using data from the National Mortality System. The rates were highest among individuals classified as "black" and lower among those classified as "mixed-race", with a continuous increase among the later from 1999 to 2004 for men and women. Among individuals classified as "white", mortality rates remained stable among men, but not women. Median age at death among "mixed-race" individuals was lower for both men and women. Differential trends according to gender and "race or color" were highlighted by the present study, indicating the pressing need to further explore the underlying factors that might explain different mortality rates in a context of universal access

Mortalidade por AIDS, “raça/cor” e desigualdade social, em um contexto de acesso universal à terapia anti-retroviral de alta potência (HAART) no Brasil, 1999-2004

Submitted by Frederico Azevedo ([email protected]) on 2010-11-08T12:28:11Z No. of bitstreams: 1 aids_mortality.pdf: 212499 bytes, checksum: b8bbf408588ab8703f32a560f0d57158 (MD5)Made available in DSpace on 2010-11-08T12:28:11Z (GMT). No. of bitstreams: 1 aids_mortality.pdf: 212499 bytes, checksum: b8bbf408588ab8703f32a560f0d57158 (MD5) Previous issue date: 2007Fundação Oswaldo Cruz. Instituto de Pesquisa Evandro Chagas. Rio de Janeiro, RJ, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Brasília, DF, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Brasília, DF, Brasil.Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil.A terapia anti-retroviral de alta potência (HAART) tem determinando substancial aumento da sobrevida de pessoas vivendo com AIDS, ainda que de forma heterogênea entre populações de diferentes condições sociais e econômicas. Este estudo analisa a mortalidade por AIDS no Brasil, num período em que a HAART se consolida como estratégia terapêutica, explorando a hipótese da variável “raça/cor” constituir uma das vertentes das desigualdades sociais e econômicas no Brasil. Foram calculadas taxas de mortalidade por AIDS, por sexo e “raça/cor”, utilizando-se dados do Sistema de Informações sobre Mortalidade. As maiores taxas de mortalidade foram observadas nos indivíduos de “raça/cor” preta e as menores naqueles de “raça/cor” parda, ainda que com crescimento persistente no período observado (1999-2004), em ambos os sexos. Entre os indivíduos de “raça/cor” branca, observou-se estabilidade na taxa de mortalidade apenas entre os homens. A idade mediana dos óbitos na “raça/cor” parda foi invariavelmente mais baixa, para ambos os sexos. Tendências diferenciadas por sexo e “raça/cor” foram observadas, exigindo estudos adicionais que explorem os fatores que determinam diferenciais nas taxas de mortalidade num contexto de acesso universal.Highly active antiretroviral therapy (HAART) has led to a substantial increase in the survival of people living with AIDS, despite heterogeneities among individuals from different socioeconomic strata. The present paper analyzes AIDS deaths in Brazil during a period in which HAART became a key treatment regimen, exploring the hypothesis that “race or color” defines one dimension of socioeconomic inequality in Brazil. AIDS mortality, stratified by gender and “race or color”, was calculated using data from the National Mortality System. The rates were highest among individuals classified as “black” and lower among those classified as “mixed-race”, with a continuous increase among the later from 1999 to 2004 for men and women. Among individuals classified as “white”, mortality rates remained stable among men, but not women. Median age at death among “mixedrace” individuals was lower for both men and women. Differential trends according to gender and “race or color” were highlighted by the present study, indicating the pressing need to further explore the underlying factors that might explain different mortality rates in a context of universal access

Differential Survival Benefit of Universal HAART Access in Brazil: A Nation-Wide Comparison of Injecting Drug Users Versus Men Who Have Sex With Men

Submitted by Cléa Mara Barradas ([email protected]) on 2010-11-04T17:52:55Z No. of bitstreams: 1 Bastos_Differential survival benefit.pdf: 177119 bytes, checksum: 6e6bfe43c836b315d57c922309c2161b (MD5)Made available in DSpace on 2010-11-04T17:52:55Z (GMT). No. of bitstreams: 1 Bastos_Differential survival benefit.pdf: 177119 bytes, checksum: 6e6bfe43c836b315d57c922309c2161b (MD5) Previous issue date: 2009Oswaldo Cruz Foundation. Sergio Arouca School of Public Health. Social Science Department. Rio de Janeiro, RJ, Brazil.Oswaldo Cruz Foundation. Health Information Department, Center for Scientific and Technological Information. Rio de Janeiro, RJ, Brazil.Oswaldo Cruz Foundation. Sergio Arouca School of Public Health. Department of Epidemiology and Quantitative Methods. Rio de Janeiro, RJ, Brazil.Brazilian National STD/AIDS Program. Surveillance Unit. Brasilia, DF, Brazil.Brazilian National STD/AIDS Program. Surveillance Unit. Brasilia, DF, Brazil.Oswaldo Cruz Foundation. Evandro Chagas Clinical Research Institute. Rio de Janeiro, RJ, Brazil.University of California. School of Medicine. Department of Family and Preventive Medicine. Division of International Health and Cross Cultural Medicine. San Diego, CA, USA.Objective: Brazil accounts for ;70% of injection drug users (IDUs) receiving highly active antiretroviral therapy (HAART) in low-income/middle-income countries. We evaluated the impact of HAART availability/access on AIDS-related mortality among IDUs versus men who have sex with men (MSM). Design: Nation-wide analysis on Brazilian IDU and MSM diagnosed with AIDS in 2000–2006. Methods: Four national information systems were linked, and Cox regression was used to assess impact of HAART availability/access on differential AIDS-related mortality. Results: Among 28,426 patients, 6777 died during 87,792 personyears of follow-up. Compared with MSM, IDU were significantly less likely to be receiving HAART, to have ever had determinations for CD4 or viral load. After controlling for confounders, IDU had a significantly higher risk of death (adjusted hazard ratio: 1.94; 95% confidence interval: 1.84 to 2.05). Among the subset that had at least 1 CD4 and viral load determination, higher risk of death among IDU persisted (hazard ratio: 1.82; 95% confidence interval: 1.58 to 2.11). Nonwhite ethnicity significantly increased this risk, whereas prompt HAART uptake after AIDS diagnosis reduced the risk of death. After controlling for spatially correlated survival data, AIDS-related mortality remained higher in IDU than in MSM. Conclusions: Despite free/universal HAART access, differential AIDS-related mortality exists in Brazil. Efforts are needed to identify and eliminate these health disparities